Complications
Nearly 60% of all patients with compensated cirrhosis will develop ascites within 10 years.[157] Ascites is the most common complication of cirrhosis. In most instances it can be well controlled with diuretics and a low-sodium diet. The 2-year survival of patients with ascites is about 50%.[158] Ascites can also manifest as a hepatic hydrothorax.
Seen in 25% to 40% of patients with cirrhosis.[159] Variceal haemorrhage is a devastating complication of cirrhosis. About one third of patients with varices will bleed. Prior to the widespread use of current therapies for acute variceal haemorrhage, the mortality rate of a single variceal haemorrhage was 30% and only one third of patients survived for 1 year.[160]
Seen in 30% to 45% of patients with cirrhosis.[161] Usually has an identifiable precipitator, most commonly infection, gastrointestinal bleeding, medication non-compliance, electrolyte disturbances, or portal vein thrombus.
Incidence approximately 3% per year.[162][163] May occur in the absence of cirrhosis.[163] Risk factors include obesity, type 2 diabetes, advanced age, male sex, and various genetic polymorphisms.[164] Patients with cirrhosis, and patients who have evidence of advanced fibrosis or cirrhosis on non-invasive testing, should be offered screening for hepatocellular carcinoma.[163] Screening is initially performed with ultrasound and measurement of serum alpha-fetoprotein.[165]
Seen in 18% at 1 year and 39% at 5 years in patients with cirrhosis and ascites.[166]
The diagnosis is one of exclusion, being made when other causes of renal dysfunction have been ruled out. The prognosis is poor unless hepatic function improves.
Results from portal hypertension and occurs in at least 5% of patients awaiting liver transplantation.[167] Symptoms include dyspnoea and platypnoea (shortness of breath that is worse when upright).
The presence of hepatopulmonary syndrome should prompt immediate evaluation for liver transplantation.
The condition usually resolves following liver transplantation.[168]
Advanced fibrosis (stages 3 and 4) is associated with increased mortality.[16] The Child-Pugh classification system correlates with survival; 1-year survival rates for patients with Child A, B, and C cirrhosis are about 100%, 80%, and 45%, respectively.[169] Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) have an increased risk of fatal cardiovascular events, particularly if they have advanced fibrosis, independent of other cardiovascular risk factors.[104]
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