Cirrhosis of the liver is a chronic, progressive disease that causes extensive scarring of the liver tissue. There are several stages of cirrhosis, with the last stage being end-stage cirrhosis or decompensated cirrhosis. This final stage signals that the liver is failing and is marked by the onset of major complications.
What are the stages of cirrhosis?
Cirrhosis develops slowly over many years and progresses through different stages:
- Early cirrhosis – There is scarring of the liver but normal liver function. Often no symptoms.
- Compensated cirrhosis – More scarring that starts to impact liver function, but the liver is still able to perform its essential processes. Some symptoms may be present.
- Decompensated cirrhosis – Widespread scarring associated with loss of liver function. Symptoms are more prominent.
- End-stage cirrhosis – Severe scarring and liver failure. Life-threatening complications arise.
The progression to end-stage disease can take anywhere from 10-20 years. Not all patients will reach this final stage if the underlying cause of cirrhosis is treated.
What happens in end-stage cirrhosis?
In end-stage cirrhosis, the liver sustains severe, irreversible scarring. At this point, the liver cannot effectively perform its critical functions, which include:
- Processing nutrients, toxins and medications
- Producing proteins, clotting factors and bile
- Helping regulate blood sugar and cholesterol
As a result, end-stage cirrhosis leads to a number of serious complications and symptoms:
Liver failure
Extensive scarring impairs the liver’s ability to carry out its vital chemical processes. Toxins build up in the bloodstream and the body’s metabolism is disrupted.
Portal hypertension
Pressure increases in the portal vein system that brings blood from the intestines and spleen to the liver. This triggers bleeding problems.
Esophageal varices
Dilated blood vessels in the lower esophagus may swell and burst, causing bloody vomiting.
Ascites
Abdominal fluid accumulation leads to swelling and discomfort.
Spontaneous bacterial peritonitis
Bacteria infect the ascites fluid, causing abdominal pain, fever and diarrhea.
Hepatic encephalopathy
Toxins reaching the brain lead to confusion, sleepiness and coma.
Kidney failure
The liver supports kidney function. As liver failure progresses, toxins build up and kidney function declines.
Jaundice
Yellowing of the skin and eyes due to excess bilirubin, a byproduct of old red blood cells.
Bleeding problems
Reduced production of clotting factors leads to easy bruising and bleeding from the nose or gastrointestinal tract.
Sensitivity to medications
The liver cannot metabolize drugs effectively, risking drug toxicity.
Multiple organ failure
End-stage cirrhosis can ultimately lead to failure of several organ systems.
How is end-stage cirrhosis diagnosed?
Doctors diagnose end-stage cirrhosis based on a patient’s symptoms, physical examination findings, and test results. Characteristic findings include:
- Enlarged liver or spleen
- Fluid buildup in the abdomen
- Jaundice
- Changes in mental function
- Easy bruising or bleeding
Diagnostic tests confirm extensive liver damage and function loss. These may include:
- Blood tests to check liver enzymes, proteins and electrolytes
- Imaging tests like CT, MRI or ultrasound of the liver
- Endoscopy to check for esophageal varices
- Liver biopsy to examine liver tissue under a microscope
What is the life expectancy with end-stage cirrhosis?
End-stage cirrhosis indicates that liver failure is imminent and complications are intensifying. At this point, patients will require hospitalization and intensive care to manage their symptoms. Life expectancy is difficult to predict, but research shows:
- The median survival time without a liver transplant is between 1-3 years.
- The 1-year survival rate is about 50% for those with end-stage disease.
- Up to 20% of patients may survive more than 5 years.
- Survival time depends on the specific complications and how well they respond to treatment.
A liver transplant may significantly improve long-term survival. Patients with end-stage cirrhosis are listed for expedited transplant. Still, survival depends on finding a suitable donor and recovery after transplant surgery.
Can end-stage cirrhosis be treated or cured?
There is no cure for end-stage cirrhosis, but treatment can help manage symptoms and complications. The goals of care are to:
- Treat the underlying cause, such as chronic hepatitis C
- Prevent and manage complications
- Replace nutrients the liver cannot make
- Prepare for liver transplant
Treatment options may include:
- Medications – Diuretics, beta blockers, antibiotics, laxatives
- Diet changes – Lower sodium, higher protein
- Supplements – Vitamins A, D, E, K, zinc, branched-chain amino acids
- Procedures – Paracentesis to drain fluid, banding of esophageal varices
- Liver transplant – Replaces the diseased liver if life expectancy is threatened
Even with treatment, end-stage cirrhosis cannot be reversed and liver function cannot be fully restored. Supportive care focuses on managing symptoms and preventing complications to prolong survival.
What is the prognosis and life expectancy if untreated?
Leaving end-stage cirrhosis untreated typically leads to a poor prognosis and shortened life expectancy. Without care, patients often deteriorate and die within weeks or months.
This terminal phase is called acute-on-chronic liver failure (ACLF). It involves:
- Multiple organ failure
- Sepsis or systemic inflammatory response syndrome (SIRS)
- Progressively worsening liver function
ACLF has a high mortality rate. Studies show:
- 28-day mortality may exceed 50%
- 90-day mortality may exceed 80%
The exact prognosis varies between patients and depends on factors like:
- Cause and severity of cirrhosis
- Number of organs failing
- Presence of sepsis
- Availability of liver transplant
Still, end-stage cirrhosis ultimately leads to multi-organ failure if left untreated. Death most often results from:
- Bleeding esophageal varices
- Infections
- Kidney failure
- Hepatic encephalopathy leading to brainstem herniation
Seeking medical care and adhering to treatment recommendations are vital for end-stage cirrhosis patients. Supportive care and management of complications aim to prolong survival as much as possible.
What are the symptoms of end-stage cirrhosis?
End-stage cirrhosis produces some distinct symptoms as liver function declines and complications set in. Patients may experience:
- Jaundice – Yellowing of the skin and whites of the eyes
- Itching – Due to bile salts deposited in the skin
- Fatigue – Due to inadequate nutrient processing
- Nausea or loss of appetite – Due to altered metabolism
- Weight loss and muscle wasting – Due to impaired nutrient absorption
- Abdominal swelling (ascites) – Due to fluid accumulation
- Edema – Swelling in the legs from low albumin
- Bruising and bleeding – Due to low platelet and clotting factors
- Confusion (encephalopathy) – Due to toxins reaching the brain
In addition, complications like esophageal varices and spontaneous bacterial peritonitis cause symptoms such as:
- Bloody vomit or black, tarry stool
- Abdominal pain
- Fever
- Diarrhea
These symptoms impair quality of life and ability to work. Most end-stage cirrhosis patients require hospitalization to manage their various issues.
What causes end-stage cirrhosis?
Cirrhosis has many possible causes, including:
- Chronic alcohol abuse
- Chronic viral hepatitis (B and C)
- Nonalcoholic fatty liver disease
- Autoimmune disease
- Bile duct disorders
- Exposure to toxins
- Genetic diseases like hemochromatosis and Wilson’s disease
In most cases, cirrhosis develops after years or even decades of continuous liver injury. The organ responds through fibrous scarring, which eventually leads to widespread dysfunction.
Alcoholic liver disease
Drinking too much alcohol can have toxic effects on liver cells, triggering inflammation and scarring. About 20% of heavy drinkers develop cirrhosis.
Chronic viral hepatitis
Hepatitis B and C viruses cause persistent liver inflammation. This results in progressive fibrosis over 10-20 years, eventually leading to cirrhosis.
Nonalcoholic fatty liver disease (NAFLD)
Fat accumulation with liver inflammation can scar the liver over time. Up to 25% of people with NAFLD may progress to advanced fibrosis and cirrhosis.
Autoimmune disease
In autoimmune conditions like autoimmune hepatitis, the immune system attacks and damages liver tissue. This can result in cirrhosis.
Metabolic disorders
Genetic diseases like hemochromatosis and Wilson’s disease cause abnormal mineral metabolism and liver cell damage. Cirrhosis may develop.
No matter the cause, worsening fibrosis ultimately leads to end-stage cirrhosis with liver failure.
Is end-stage cirrhosis reversible?
Unfortunately, end-stage cirrhosis is generally considered irreversible. Once the liver sustains severe fibrosis and functional impairment, the damage cannot be reversed with today’s treatment options.
Advanced cirrhosis represents the final stage of chronic liver disease progression. At this point:
- Scar tissue extensively replaces normal liver tissue
- Blood flow through the liver is impaired
- The liver cannot regenerate effectively
Treatments can only prevent further liver injury and manage complications. They cannot undo the years of accumulated scar tissue.
Some key points about reversing end-stage cirrhosis:
- Fibrosis is a dynamic process, but cirrhosis is difficult to undo once established
- Removing the cause may halt further scarring, but does not restore lost liver function
- No medications are approved to reverse cirrhosis
- Only a liver transplant provides a new, healthy liver
Researchers continue seeking ways to halt and potentially reverse cirrhosis. But currently, a cure is not possible except through transplantation.
What is the difference between compensated and decompensated cirrhosis?
Cirrhosis is considered compensated when the liver can still perform its critical functions despite some scarring. Decompensated cirrhosis means that scarring is so severe that liver function is impaired.
The key differences between compensated and decompensated cirrhosis are:
| Compensated Cirrhosis | Decompensated Cirrhosis |
|---|---|
| Milder fibrosis and damage | Widespread fibrosis and damage |
| Preserved liver synthetic function | Declining synthetic function |
| Few symptoms | Symptoms more prominent |
| No complications | Complications like ascites, varices, encephalopathy |
| Normal life expectancy | Reduced life expectancy |
Many patients have compensated cirrhosis for years before progressing to decompensation and liver failure. Regular monitoring helps detect increasing complications.
Conclusion
End-stage cirrhosis represents the final phase of chronic liver disease where fibrosis is severe and organ function declines. Major complications like esophageal varices, ascites and encephalopathy arise, requiring hospitalization.
Life expectancy without a liver transplant is 1-3 years on average after reaching this advanced stage. Supportive treatment focuses on managing symptoms and preventing complications to prolong survival.
The development of end-stage cirrhosis may be prevented through early treatment of liver injury. However, once established, the extensive cirrhosis scarring cannot be reversed. A liver transplant is the only option to replace the failing cirrhotic liver.
