Assessment of Prognosis of Cirrhosis

François Durand, M.D.; Dominique Valla, M.D.

Disclosures

Semin Liver Dis. 2008;28(1):110-122. 

In This Article

General Principles and Natural History of Cirrhosis

Any patient with cirrhosis carries a risk of specific life-threatening complications such as variceal bleeding, sepsis, or hepatorenal syndrome. There is also a significant risk of nonspecific life-threatening complications due to the frequent association of comorbidities. The general course of the disease is characterized by a longstanding phase of compensated cirrhosis, followed by the occurrence of specific complications. It has been shown that 10 years after diagnosis, the probability of developing decompensated cirrhosis is ∼60%, ascites being the most frequent complication (∼50%).[1] Once patients have developed the first episode of decompensation, complications tend to accumulate and life expectancy is markedly reduced. A schematic representation of the course of cirrhosis according to four consecutive clinical stages is shown in Table 1 .[2]

The course of cirrhosis is extremely variable from patient to patient due to several factors, including hepatic synthetic function (or “hepatic reserve”), the cause of cirrhosis, the possibility of stopping or slowing the underlying damaging process to the liver, and the occurrence of liver malignancy. Therefore, establishing a prognosis in a given patient with cirrhosis remains a challenging issue. In addition to the simple estimation of life expectancy, more complex issues must be taken into account, such as the capacity of a cirrhotic patient to withstand a given therapeutic intervention, or whether a given therapeutic option offers an acceptable chance of survival. Over the last couple of decades, additional complex issues have emerged with the generalization of liver transplantation, namely, the optimal timing for transplantation and, on a collectivity basis, the optimization of allocation policy in a context of organ shortage.

Even though the course of cirrhosis varies according to several factors, the need for prognostic models and scoring systems is obvious in order to manage individuals faced with different therapeutic options. Scoring systems are even more crucial for managing populations of patients in the setting of transplantation, for instance. Major efforts have been made in recent years to achieve these goals and develop prognostic tools which are detailed below. Hepatocellular carcinoma (HCC) will not be discussed in this article.

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