Prediction of Decompensation in Patients with Compensated Cirrhosis: Does Etiology Matter?

Transition from compensated to decompensated cirrhosis, defined by overt clinical signs, represents a turning point in the clinical course of the disease. In fact, while compensated cirrhosis is a silent disease characterized by long survival, decompensated cirrhosis is associated with symptoms markedly reducing the quality of life and with a median survival of 2–4 years. Therefore, identifying predictors of decompensation and investigating potential interventions for its prevention is a major objective. Mechanisms and incidence of decompensation, together with its predictors, are summarized here, with regard to the etiology of the disease. In a total of 92 studies including 105 cohorts and 152,320 patients, the mean ± SD 5-year decompensation rate was 24.5 ± 13.6%. The 5-year decompensation rate was significantly different across different etiologies, ranging from 12.8% for biliary etiologies to 33.6% in alcoholic liver disease (p