Prediction of Decompensation in Patients with Compensated Cirrhosis: Does Etiology Matter?

Abstract

Transition from compensated to decompensated cirrhosis, defined by overt clinical signs, represents a turning point in the clinical course of the disease. In fact, while compensated cirrhosis is a silent disease characterized by long survival, decompensated cirrhosis is associated with symptoms markedly reducing the quality of life and with a median survival of 2–4 years. Therefore, identifying predictors of decompensation and investigating potential interventions for its prevention is a major objective. Mechanisms and incidence of decompensation, together with its predictors, are summarized here, with regard to the etiology of the disease. In a total of 92 studies including 105 cohorts and 152,320 patients, the mean ± SD 5-year decompensation rate was 24.5 ± 13.6%. The 5-year decompensation rate was significantly different across different etiologies, ranging from 12.8% for biliary etiologies to 33.6% in alcoholic liver disease (p < 0.0001). The most frequently reported significant predictors of decompensation were liver function, portal hypertension, and inflammation/fibrosis indicators. Etiologic treatment was associated with significant risk reduction. While the risk of decompensation significantly varies across different etiologies of cirrhosis, etiology per se has not been properly studied as a decompensation predictor. Although decompensation appears to be related more to inflammation/fibrosis and portal hypertension, the causing factors may determine different activation intensity of the decompensating mechanisms.