Natural History and Stages of Cirrhosis

The natural history of cirrhosis is characterized by an asymptomatic phase, referred to as “compensated cirrhosis,” followed by a progressive phase marked by the development of complications of portal hypertension and/or liver dysfunction, designated “decompensated cirrhosis.” In the compensated phase portal pressure may be normal or below the threshold of clinically significant portal hypertension [1] although esophageal varices may appear still in the compensated phase of the disease. Decompensation is defined by the development of ascites, portal hypertensive gastrointestinal (GI) bleeding, encephalopathy, or jaundice [2]. Progression of the decompensated disease may be accelerated by the development of other complications such as (re)bleeding, renal impairment [refractory ascites, hepatorenal syndrome (HRS)], hepatopulmonary syndrome, and sepsis [spontaneous bacterial peritonitis (SBP)]. The development of hepatocellular carcinoma (HCC) may accelerate the course of the disease at any stage. This chapter summarizes the major steps in the progression of cirrhosis through the compensated and the decompensated phases of the disease, and its prognostic indicators. Chapter 2 Natural History and Stages of Cirrhosis