Longer Walking Distance, More Fat, Better Survival: Prognostic Indicators of Liver Cirrhosis
Year: 2021
Type: editorial
Abstract: Liver cirrhosis is the late stage of progressive hepatic fibrosis and chronic liver disease, leading to distortion of the architecture of the liver and growth of regenerative nodules.Cirrhosis is characterized by an important burden of disease and decreased life expectancy.The prognosis of cirrhosis is highly variable and is influenced by etiology, severity, presence of complications, and comorbid diseases.Mortality rates are high when clinical decompensation becomes apparent with ascites, variceal hemorrhage, encephalopathy, portal hypertensive gastropathy, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatopulmonary syndrome, porto-pulmonary syndrome, cirrhotic cardiomyopathy, hepatocellular carcinoma, and portal vein thrombosis.Upon decompensation, cirrhosis becomes lethal or requires liver transplantation.In the United States cirrhosis accounts for almost 50,000-66,000 deaths, of which 18,000-19,500 are attributable to liver cancer [1,2].Secondary prevention and identification of complications in cirrhotic patients have a significant impact on the prognosis, and great attention should be paid to regular screening for esophageal varices, hepatocellular carcinoma, and prudent diuresis, as well as the judicious use of proton pump inhibitors to prevent spontaneous bacterial peritonitis, and treatment of infections predisposing to spontaneous bacterial peritonitis and hepatic encephalopathy.Avoiding sedatives and treating electrolyte disturbances, i.e. hypokalemia and hyponatremia, could prevent hepatic encephalopathy.In addition, avoiding nephrotoxic agents and aggressive diuresis can prevent hepatorenal syndrome.In this context, the prediction of both liver decompensation and mortality risk is a challenging task in clinical medicine, including planning optimal management of disease, improving the survival rate, and solving the best drug treatment.Based on clinical information and laboratory tests, two commonly used models to predict the prognosis of patients with cirrhosis are (i) the Child-Pugh classification that is based on serum albumin and bilirubin, ascites, encephalopathy, and prothrombin time; and (ii) the Model for End-
DOI: 10.15403/jgld-3455
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W3139359708