Cirrhosis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Natural history, Complications, Prognosis

Complications

As the disease progresses, complications may develop. In some people, these may be the first signs of the disease.

• Bruising and bleeding due to decreased production of coagulation factors.
• Jaundice due to decreased processing of bilirubin.
• Itching (pruritus) due to bile products deposited in the skin.
• Hepatic encephalopathy - the liver does not clear ammonia and related nitrogenous substances from the blood, which are carried to the brain, affecting cerebral functioning: neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleep habits.
• Sensitivity to medication due to decreased metabolism of the active compounds.
• Hepatocellular carcinoma is primary liver cancer, a frequent complication of cirrhosis. It has a high mortality rate.
• Portal hypertension - blood normally carried from the intestines and spleen through the hepatic portal vein flows more slowly and the pressure increases; this leads to the following complications:
  • Ascites - fluid leaks through the vasculature into the abdominal cavity.
  • Esophageal varices - collateral portal blood flow through vessels in the stomach and esophagus. These blood vessels may become enlarged and are more likely to burst.
• Problems in other organs.
  • Cirrhosis can cause immune system dysfunction, leading to infection. Signs and symptoms of infection may be aspecific are more difficult to recognize (e.g. worsening encephalopathy but no fever).
  • Fluid in the abdomen (ascites) may become infected with bacteria normally present in the intestines (spontaneous bacterial peritonitis).
  • Hepatorenal syndrome - insufficient blood supply to the kidneys, causing acute renal failure. This complication has a very high mortality (over 50%).
  • Hepatopulmonary syndrome - blood bypassing the normal lung circulation (shunting), leading to cyanosis anddyspnea(shortness of breath), characteristically worse on sitting up.
  • Portopulmonary hypertension - increased blood pressure over the lungs as a consequence of portal hypertension.

Risk Stratification and Prognosis

Well-Compensated, no EtOH	35% mortality at 2 years
Onset of Ascites	50% mortality at 2 years
Variceal bleeding	65% mortality at 1 year (35% short-term mortality)

References

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