Cirrhosis is a chronic, progressive condition that causes extensive liver scarring and damage. It has a variety of causes, including chronic viral hepatitis, alcohol abuse, and fatty liver disease. Cirrhosis cannot be cured, but treatment can stop or delay its progression and reduce complications. With proper care, many people with cirrhosis can live for years. However, cirrhosis shortens average life expectancy to some degree. How long someone lives depends on several factors.
What is cirrhosis?
Cirrhosis occurs when liver cells are damaged and replaced by scar tissue. Healthy liver tissue is lost over time. As cirrhosis gets worse, the liver loses function and cannot properly remove toxins from the blood or produce essential proteins and other substances. Cirrhosis has many possible causes:
– Chronic hepatitis B or C – viral infections that damage the liver over many years. Treating the viral infection can stop cirrhosis progression.
– Alcohol abuse – consistently drinking too much alcohol. Stopping alcohol use is essential to maximize longevity.
– Nonalcoholic fatty liver disease – fat buildup and inflammation of the liver, often seen in people who are obese or have diabetes. Weight loss and managing diabetes can help.
– Autoimmune liver diseases – conditions where the immune system mistakenly attacks liver cells. Medications that suppress the immune system can help.
– Inherited diseases like hemochromatosis – where the body absorbs and stores too much iron. Removing excess iron from the body with phlebotomy is the treatment.
– Bile duct issues that damage liver cells.
– Exposure to toxins.
Cirrhosis develops slowly, often over 10 to 20 years. Many people have no symptoms in the early stages. Once significant scarring occurs, the liver cannot function normally. Symptoms of advanced cirrhosis include:
– Fluid retention and swelling in the legs, feet, and abdomen
– Jaundice – yellow discoloration of the skin and eyes
– Easy bruising and abnormal bleeding due to decreased production of blood-clotting proteins
– Fatigue and weakness
– Loss of appetite and weight loss
– Spider-like blood vessels visible under the skin
– Itchy skin
– Sleep disruption
– Impotence in men
– Confusion and impaired brain function
– Vomiting blood
– Gallstones
People with cirrhosis are vulnerable to potentially life-threatening complications such as infections, kidney failure, internal bleeding, and liver cancer. Getting appropriate treatment improves quality of life and lifespan.
How long can someone with cirrhosis expect to live?
With cirrhosis, survival rates depend significantly on the extent of liver damage and complications when the disease is diagnosed. In general:
– People with compensated cirrhosis – where the liver is damaged but still functions somewhat normally – often live for more than 10 years after diagnosis.
– Those with decompensated cirrhosis – where the liver cannot perform essential functions – have a median survival time of 2 years.
– Once severe complications like bleeding varices, ascites, or liver cancer develop, life expectancy is less than 1 year without a liver transplant.
According to research, here are some statistics on how long people with cirrhosis typically survive:
– At diagnosis, the 10-year survival rate is 42% for compensated cirrhosis patients. For those with decompensated cirrhosis, the 10-year survival is 20%.
– In one study of compensated cirrhosis patients, survival rates after diagnosis were:
– 1 year – 95%
– 3 years – 81%
– 5 years – 79%
– For decompensated cirrhosis, median survival is 24 months.
– With ascites, which involves fluid accumulation in the abdomen, median survival is 18 months.
– Once variceal bleeding starts, median survival is around 6 months.
– For those who have their first major complication, median survival is 13-20 months.
– Without a liver transplant, small hepatocellular carcinoma liver tumors reduce expected survival to 11-20 months.
– A Child-Pugh score helps predict cirrhosis survival. Scores range from 5-15, with higher scores indicating more advanced disease and higher mortality risk.
– 1 year survival – Child-Pugh Class A: 100%, B: 81%, C: 45%
– 2 year survival – Child-Pugh Class A: 85%, B: 57%, C: 35%
So in summary, early compensated cirrhosis has good survival rates for 5-10+ years in many cases. Once significant complications arise, expected survival drops to less than 2 years. Severe decompensation and liver cancer lower life expectancy to less than 1 year without a transplant.
What affects life expectancy with cirrhosis?
Many factors influence the survival rates and life expectancy for someone with cirrhosis. The most important include:
– Cause of cirrhosis – Hepatitis C related cirrhosis generally has better survival rates than alcohol or NASH related cirrhosis. Treating and controlling the underlying cause is key.
– Severity – Mild Child-Pugh Class A compensated cirrhosis has far better prognosis than advanced decompensated disease. The extent of liver damage matters significantly.
– Developing complications – Once variceal bleeding, hepatic encephalopathy, ascites or other issues arise, lifespan decreases substantially unless these complications can be controlled.
– Liver cancer – Hepatocellular carcinoma is a serious risk with cirrhosis. Tumor stage at diagnosis and treatment response impact survival times.
– Abstaining from alcohol – Continued alcohol abuse drastically reduces cirrhosis survival, while stopping drinking can increase longevity.
– Overall health – Life expectancy is lower for those with other health problems such as heart or lung disease. Good control of chronic health conditions is important.
– Liver transplantation – Getting a transplant can extend survival by many years in cases of decompensated cirrhosis or liver cancer.
– Adherence to treatment – Rigorously following an appropriate cirrhosis treatment plan and medical care is vital.
So the more the cirrhosis progression can be slowed and complications prevented or managed, the better one’s chances of living longer. Close monitoring and excellent care makes a big difference.
Typical clinical course of cirrhosis
The typical progression of untreated cirrhosis that leads to worsening liver function and death includes:
– Compensated cirrhosis – Extensive scarring but few symptoms or complications. Can last for years.
– Decompensated cirrhosis – Jaundice, ascites, bleeding varices, mental impairment and protein buildup indicate liver failure. Median survival 2 years.
– End-stage cirrhosis – Extreme jaundice, enlarged spleen, easy bruising and bleeding, extreme protein sensitivity, hepatic encephalopathy. Requires transplant.
– Liver cancer – High risk of hepatocellular carcinoma. Aggressive treatment can prolong life.
– Liver failure – Complete loss of liver function. Requires immediate transplant if available.
– Death – Usually due to bleeding, infection, kidney failure, liver cancer or other complications.
For those with mild stable cirrhosis that remains compensated, the disease may not significantly affect longevity. But once it advances, the liver cannot keep up with the body’s needs. Average survival decreases steadily as decompensation sets in.
Impact of cirrhosis stage and liver function tests
Doctors use liver function blood tests to assess the severity of cirrhosis. Results can indicate how far the disease has progressed and the prognosis. Some key tests include:
– Bilirubin – Elevated levels indicate worsening jaundice as liver function declines.
– Albumin – Produced by the liver, low albumin correlates with reduced survival.
– ALT/AST – Markers of liver injury rise as damage worsens.
– INR – Increased INR means decreased production of blood clotting factors.
– Platelets – Thrombocytopenia signals advanced cirrhosis.
– Sodium – Low sodium associated with shorter survival time.
The Child-Pugh Score uses bilirubin, albumin, INR and ascites/encephalopathy to determine class A, B or C. Higher classes correlate with lower life expectancy. Another scoring system called MELD uses bilirubin, INR and creatinine. Higher scores mean higher short-term mortality risk.
Liver function tests reflect cirrhosis progression. Doctors can estimate prognosis and life expectancy based on long-term trends in these test results.
Impact of cirrhosis complications
The outlook for a cirrhosis patient often depends most on the development and control of cirrhosis complications:
– Ascites – Fluid buildup increases mortality risk. Slow progression with diuretics improves prognosis.
– Varices – Ruptured varices in the esophagus and stomach have up to 50% mortality. Preventing bleeding episodes with beta blockers is key.
– Hepatic encephalopathy – Impaired brain function due to toxins reduces survival. Liver transplant may be needed.
– Spontaneous bacterial peritonitis – Abdominal infections have 30-50% mortality. Requires rapid treatment.
– Hepatorenal syndrome – Kidney failure requiring transplant arises in advanced cirrhosis. Dialysis can help temporarily.
– Hepatopulmonary syndrome – Arterial deoxygenation shortens survival. Lung or liver transplant may cure it.
– Liver cancer – Without transplant, advanced HCC has survival of less than 1 year. MELD exception improves transplant access.
Managing complications requires close medical care. But preventing them from occurring by controlling risk factors can do the most to prolong life.
Impact of underlying liver disease cause
The underlying cause of cirrhosis affects life expectancy after diagnosis. For example:
– Alcoholic cirrhosis has lower survival rates than viral hepatitis. Stopping alcohol intake and proper care can significantly improve the prognosis.
– Chronic hepatitis C responds well to antiviral drugs. Treated HCV with mild cirrhosis can have near normal life expectancy.
– NASH cirrhosis from obesity can improve with weight loss, diabetes treatment, and cholesterol control.
– Autoimmune hepatitis responds to immunosuppressant drugs and chelation therapy for hemochromatosis. Removing the cause of liver injury is beneficial.
– Primary biliary cholangitis progresses slowly so survival is often 10+ years with ursodiol treatment.
– Primary sclerosing cholangitis has poorer outcomes due to recurrent infections and bile duct damage. Median transplant-free survival is 12 years.
The cirrhosis survival rates by cause vary but are generally worse with alcohol, NASH and mixed causes compared to viral hepatitis alone.
Impact of age and other health issues
Age and other health problems also affect the prognosis for cirrhosis patients:
– Younger patients under 60 tend to have higher survival rates than older patients.
– The health of other organs impacts outcomes. Heart or kidney disease worsens prognosis.
– Older patients are more prone to sepsis and resistant infections.
– Chronic diseases like COPD, diabetes and heart disease should be well controlled.
– Older patients may be frailer and not able to manage complications as well.
– Cancer, HIV, and other comorbid conditions negatively impact survival.
So overall health, age, and chronic illnesses should be factored in when estimating life expectancy. The risks compounds when liver disease is advanced.
Role of alcohol use
Continued alcohol intake dramatically worsens cirrhosis survival while stopping boosts longevity:
– Abstinence after an alcohol-related cirrhosis diagnosis can add more than 10 years of life compared to continued drinking.
– Studies show 5-year survival rates up to 90% for abstainers compared to as low as 20% for active alcohol abuse.
– Liver scarring may stabilze or even reverse to some degree with abstinence if caught early enough.
– Alcohol accelerates liver decompensation, complications like bleeding varices, and cancer risk.
– Relapsing into alcohol abuse after a period of sobriety often triggers rapid cirrhosis progression.
So counseling, support groups, medication, and prioritizing sobriety are critical for increasing life expectancy in alcohol-related liver disease.
Role of liver transplantation
Liver transplantation has revolutionized outcomes in decompensated cirrhosis. Key transplant facts:
– Getting on the transplant list promptly is key for those with advanced disease or liver cancer. The MELD score determines waitlist priority.
– Transplant provides excellent 5-year survival rates of 75% or better for those with decompensated cirrhosis.
– 90% of early stage liver cancer patients live 5+ years after transplant compared to most having life expectancy under 1 year without it.
– Survival rates continue improving – from 43% at 5 years in the 1980s to 71% currently.
– Being too frail or having other organ failure reduces transplant outcomes. Careful patient selection is crucial.
– Living donor transplants as an option for some patients and have excellent results.
Still, demand for liver transplants continues to exceed availability. Alcohol use, medical compliance, and other factors determine transplant eligibility. But for selected patients, it provides the best hope.
How to improve life expectancy with cirrhosis
Increasing life expectancy in cirrhosis involves reducing risk of disease progression and catching complications early:
– Stop all alcohol intake and substance abuse
– Take medications as directed and get regular checkups
– Get treated for viral hepatitis or control underlying liver disease
– Adopt a very healthy diet and lose weight if obese or diabetic
– Get vaccinated against hepatitis A, hepatitis B, influenza, pneumonia
– Take liver protecting supplements like milk thistle, SAMe and antioxidants
– Avoid alcohol and medication toxicity to the liver
– Treat constipation promptly to avoid backed up waste from causing problems
– Seek care quickly for any new symptoms indicating complications
– See specialists regularly to detect issues early when they are most treatable
– Discuss transplant options early if liver function continues to deteriorate
Following doctor’s orders and adopting an overall healthy lifestyle can prolong survival significantly. But the most important factors are preventing complications and qualifying for a transplant when necessary.
Conclusion
Life expectancy with cirrhosis varies substantially based on the stage at diagnosis, cause of liver damage, development of complications, and access to transplant if needed. Mild stable cirrhosis can have good longevity, while late-stage decompensation reduces survival to less than 2 years. Protecting liver function, controlling complications, and qualifying for transplant provide the best outcomes. With excellent comprehensive care and lifestyle changes, many patients can manage cirrhosis for many years. But the prognosis depends heavily on how advanced the liver disease is and closely monitoring for signs of worsening.
