Preventing the progression of cirrhosis to decompensation and death
Villanueva, Càndid Tripathi, Dhiraj Bosch, Jaume
Villanueva, Càndid
Tripathi, Dhiraj
Bosch, Jaume
Affiliation
Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd); University Hospitals Birmingham NHS Foundation Trust; University of Birmingham; Bern University Hospital; University of Bern
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Publication date
2025-01-27
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Collections
Research Projects
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Abstract
Two main stages are differentiated in patients with advanced chronic liver disease (ACLD), one compensated (cACLD) with an excellent prognosis, and the other decompensated (dACLD), defined by the appearance of complications (ascites, variceal bleeding and hepatic encephalopathy) and associated with high mortality. Preventing the progression to dACLD might dramatically improve prognosis and reduce the burden of care associated with ACLD. Portal hypertension is a major driver of the transition from cACLD to dACLD, and a portal pressure of ≥10 mmHg defines clinically significant portal hypertension (CSPH) as the threshold from which decompensating events may occur. In recent years, innovative studies have provided evidence supporting new strategies to prevent decompensation in cACLD. These studies have yielded major advances, including the development of noninvasive tests (NITs) to identify patients with CSPH with reasonable confidence, the demonstration that aetiological therapies can prevent disease progression and even achieve regression of cirrhosis, and the finding that non-selective β-blockers can effectively prevent decompensation in patients with cACLD and CSPH, mainly by reducing the risk of ascites, the most frequent decompensating event. Here, we review the evidence supporting new strategies to manage cACLD to prevent decompensation and the caveats for their implementation, from patient selection using NITs to ancillary therapies.
Citation
Villanueva C, Tripathi D, Bosch J. Preventing the progression of cirrhosis to decompensation and death. Nat Rev Gastroenterol Hepatol. 2025 Apr;22(4):265-280. doi: 10.1038/s41575-024-01031-x. Epub 2025 Jan 27
Type
Article