Compensated and Decompensated Cirrhosis: Causes, Treatment.

Compensated cirrhosis is a mild form that may not cause symptoms. Decompensated cirrhosis causes symptoms like jaundice or abdominal swelling.

Cirrhosis is advanced liver scarring that can lead to liver failure and drastically increases your risk of liver cancer. It’s often associated with:

• long-term and high alcohol consumption
• viral hepatitis infection
• obesity

Cirrhosis can be divided into compensated and decompensated.

Compensated cirrhosis is a milder form that often doesn’t cause noticeable symptoms. Decompensated cirrhosis is a more advanced form characterized by symptoms of end stage liver failure, such as jaundice or abdominal swelling.

People with compensated cirrhosis generally have a higher survival rate and better quality of life than people with decompensated cirrhosis.

Keep reading to learn more about these two types of cirrhosis.

Compensated vs. decompensated cirrhosis symptoms

Symptoms of cirrhosis may not develop until your liver reaches the decompensated stage.

Compensated cirrhosis symptoms

You may not look or feel sick if you have compensated cirrhosis. You may experience some mild symptoms, such as:

• nausea
• fatigue
• appetite loss
• spider-like blood vessels on your skin
• weight and muscle loss

Decompensated cirrhosis symptoms

Decompensated cirrhosis is characterized by the development of symptoms of advanced liver disease, such as:

• fluid buildup in your abdomen (ascites)
• jaundice
• bleeding veins in your esophagus (bleeding varices)
• cognitive changes (hepatic encephalopathy)
• kidney failure

What causes compensated vs. decompensated cirrhosis?

Cirrhosis is scarring of your liver caused by long-term liver inflammation. Some of the potential causes include:

• drinking too much alcohol over many years
• long-term viral hepatitis infection, especially from hepatitis B or hepatitis C
• non-alcohol-related fatty liver disease (NAFLD), the buildup of fat in your liver over many years
• autoimmune hepatitis

Who gets compensated vs. decompensated cirrhosis?

Here are some of the risk factors for compensated and decompensated cirrhosis.

Compensated cirrhosis risk factors

People at risk of compensated cirrhosis include:

• people who drink more than 40 grams of alcohol or roughly three drinks per day for many years
• people with viral hepatitis
• people with NAFLD, which is highly associated with:
  • obesity
  • type 2 diabetes
  • high cholesterol
  • high blood pressure
  • metabolic syndrome
  • being older than 50 years of age
  • smoking
  • underactive thyroid

Decompensated cirrhosis risk factors

People with compensated cirrhosis who don’t take steps to try to reduce liver damage are at risk of progression to decompensated cirrhosis. For example, people with cirrhosis caused by high alcohol consumption and who continue drinking alcohol.

Potential complications of compensated vs. decompensated cirrhosis

People with compensated cirrhosis are at risk of developing decompensated cirrhosis if they don’t treat whatever caused their cirrhosis.

People with decompensated cirrhosis are at risk of developing:

• kidney failure (hepatorenal syndrome)
• high blood pressure in the veins carrying blood to your liver (portal hypertension)
• cognitive difficulties
• pleural effusion (hepatic hydrothorax)
• liver cancer
• lung failure
• high blood pressure in the arteries supplying blood to your lungs (portopulmonary hypertension)
• death

Cirrhosis is highly associated with liver cancer. About 80–90% of people with the most common type of liver cancer, called hepatocellular carcinoma, have cirrhosis.

When to contact a doctor

It’s important to get medical attention any time you think you may have a liver problem. Although cirrhosis doesn’t always cause noticeable signs and symptoms, you may experience:

• jaundice
• cognitive changes
• abdominal swelling

Diagnosing compensated or decompensated cirrhosis

Tests that doctors use to help diagnose cirrhosis include:

• a review of your family and personal medical history
• a physical exam
• a review of your symptoms
• blood tests
• imaging, such as:
  • ultrasound
  • computed tomography (CT) scans
  • magnetic resonance imaging (MRI)
  • transient elastography scan
• liver biopsy

How are compensated and decompensated cirrhosis treated?

Here’s a look at the treatment options for people with compensated and decompensated cirrhosis.

Compensated cirrhosis treatment

Cirrhosis doesn’t have a cure, but addressing the underlying cause can stop its progression. A doctor may recommend:

• quitting alcohol
• losing weight if you have overweight
• taking medications to lower your cholesterol and triglyceride levels
• taking immunosuppressive medications
• antivirals

Decompensated cirrhosis treatment

Treatment of decompensated cirrhosis focuses on treating your specific complications from decompensation, such as lactulose for hepatic encephalopathy and antibiotics for spontaneous bacterial peritonitis.

People with decompensated cirrhosis may require a liver transplant. A liver transplant involves replacing your liver with a liver from a deceased donor or part of a liver from a living donor.

Learn more about liver transplants.

Outlook and life expectancy of compensated and decompensated cirrhosis

Here’s a look at the outlooks for people with compensated and those with decompensated cirrhosis.

Compensated cirrhosis life expectancy and outlook

People with compensated cirrhosis generally have a better outlook than those with decompensated cirrhosis. Half of people with compensated cirrhosis live longer than about 12 years after receiving diagnosis.

Decompensated cirrhosis life expectancy and outlook

People with decompensated cirrhosis have a significantly worse outlook. Half of people with it live fewer than 2 years after receiving diagnosis.

Can you prevent compensated or decompensated cirrhosis?

Some causes of liver disease are preventable, such as high alcohol consumption and obesity. Some ways you can protect your liver include:

• consuming a moderate amount or no alcohol
• eating a healthy diet and exercising regularly
• losing weight if you have overweight
• receiving the hepatitis A and B vaccines
• taking prescription medications as prescribed and avoiding overdose
• avoiding the use of illegal drugs or herbs known to harm your liver
• not exceeding the recommended dose of acetaminophen (Tylenol)

Frequently asked questions about compensated and decompensated cirrhosis

These are some frequently asked questions people have about compensated and decompensated cirrhosis.

How long can you stay in compensated cirrhosis?

Some people have compensated cirrhosis without progressing to decompensated cirrhosis for many years if they practice healthy lifestyle habits. About half of people with it live at least 12 years after receiving their diagnosis.

Can compensated cirrhosis be reversed?

Cirrhosis is generally not considered curable. Although there’s some growing evidence that suggests that some of the liver damage caused by cirrhosis may be somewhat reversible.

What stage is decompensated and compensated cirrhosis?

Decompensated cirrhosis is considered to be end stage liver disease. Compensated cirrhosis is an earlier stage that can progress to decompensated cirrhosis if the underlying cause isn’t addressed.

Takeaway

The best treatment for cirrhosis is avoiding whatever caused your liver damage. If your liver becomes severely damaged, the only effective treatment is a liver transplant.