Understanding the Difference Between Compensated and Decompensated Cirrhosis

Cirrhosis of the Liver: Understanding Compensated and Decompensated Stages

Cirrhosis of the liver is a serious condition that can lead to complications if left untreated. This article explores the difference between compensated and decompensated cirrhosis and what you need to know about each stage.

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What is Compensated and Decompensated Cirrhosis?

Cirrhosis is the end stage of any chronic liver disease. It involves fibrosis and the conversion of the normal architecture of the cells in the liver into abnormal nodules called regenerative nodules. The two types are differentiated based on severity.

Compensated Cirrhosis

Compensated cirrhosis is where biochemical, radiologic, and histologic findings are consistent with cirrhosis, but the liver synthetic function is preserved without complications related to portal hypertension, such as ascites, varices, or jaundice. People with compensated cirrhosis do not show symptoms, with a 10-year survival rate of more than 90%.¹

Decompensated Cirrhosis

Decompensated cirrhosis is diagnosed when there is evidence of complications of liver dysfunction alongside reduced hepatic synthetic function and portal hypertension such as ascites, jaundice, variceal bleeding, or hepatic encephalopathy. People with decompensated cirrhosis have a median survival time of two years.²

Symptoms of Compensated vs. Decompensated Cirrhosis

Compensated cirrhosis may be asymptomatic or have nonspecific symptoms such as anorexia, weakness, and weight loss, but they will not have signs and symptoms associated with portal hypertension. Decompensated cirrhosis is the stage in which your liver struggles to complete its usual duties, and your systems start to slow.

Compensated Cirrhosis Symptoms

• Anorexia
• Weakness
• Weight loss

Decompensated Cirrhosis Symptoms

• Exhaustion
• Easy bruising
• Easy bleeding
• Hematemesis & melena (blood in vomitus and blood in stool)
• Yellowed skin and whites of eyes (jaundice)
• Itchiness
• Hand and nail features such as leukonychia, palmar erythema, and spider nevi
• Facial features such as telangiectasia, spider nevi, and jaundiced sclera
• Abdominal features (collateral circulation, distention, hepatosplenomegaly)
• Swollen ankles and legs due to fluid buildup
• Hepatic fetor
• Fluid buildup in the abdomen (ascites)
• Pain in the abdomen
• Nausea
• Fever
• Weight loss
• Loss of appetite
• Confusion, loss of memory, insomnia (hepatic encephalopathy)
• Variceal hemorrhage (life-threatening bleeding from abnormal veins in the esophagus)

Causes of Cirrhosis

Cirrhosis can develop from any chronic liver disease that damages the liver, causing it to become fibrotic. It can be caused by a wide variety of conditions and diseases, including:

• Alcohol-related liver disease
• Chronic viral hepatitis (B (∓D), and C)
• Non-alcoholic fatty liver disease
• Excess of iron in the body (hemochromatosis)
• Cystic fibrosis
• Wilson disease
• Infection, e.g., syphilis, echinococcosis, or brucellosis
• Some medications, including methotrexate or amiodarone
• Autoimmune liver disease
• Problems with your bile ducts (biliary atresia or