Clinical states of cirrhosis and competing risks
Abstract
The clinical course of cirrhosis is mostly determined by the progressive increase of portal hypertension, hyperdynamic circulation, bacterial translocation and activation of systemic inflammation. Different disease states, encompassing compensated and decompensated cirrhosis and a late decompensated state, are related to the progression of these mechanisms and may be recognised by haemodynamic or clinical characteristics. While these disease states do not follow a predictable sequence, they correspond to varying mortality risk. Acute-on-chronic liver failure may occur either in decompensated or in compensated cirrhosis and is always associated with a high short-term mortality. The increasing severity of these disease states prompted the concept of clinical states of cirrhosis. A multistate approach has been considered to describe the clinical course of the disease. Such an approach requires the assessment of the probabilities of different outcomes in each state, which compete with each other to occur first and mark the transition towards a different state. This requires the use of competing risks analysis, since the traditional Kaplan-Meier analysis should only be used in two-state settings. Accounting for competing risks also has implications for prognosis and treatment efficacy research. The aim of this review is to summarise relevant clinical states and to show examples of competing risks analysis in multistate models of cirrhosis.
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Any hepatic decompensation significantly impairs prognosis in cirrhotic patients.
“Apart from treating esophageal varices, patients with NAFLD‐associated ACLD should be classified as either being “compensated‐” or “decompensated”, since any hepatic decompensation significantly impairs prognosis in cirrhotic patients [101, 102].”
From Current treatment of non‐alcoholic fatty liver disease (2022) · cites this paper as [102]
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- Authors
- D'Amico, G., Morabito, A., D'Amico, M., Pasta, L., Malizia, G., Rebora, P., & Valsecchi, M. G.
- Affiliations
- University of Milan (IT)
- Ospedale Vincenzo Cervello (IT)
- University of Milano-Bicocca (IT)
- Corresponding author
- Rebora, Paola
- Valsecchi, Maria Grazia
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 68
- Issue
- 3
- Pages
- 563-576
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W2765808825
- Cited by
- 536
- References
- 9
- Citations by year
- 2026: 43 · 2025: 91 · 2024: 97 · 2023: 75 · 2022: 74 · 2021: 69 · 2020: 50 · 2019: 26 · 2018: 11
- FWCI
- 3.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hepatology (publishedVersion)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Funders
- MIUR (RBSI14LOVD)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- liver cirrhosis, competing risks, multi-state models, decompensated cirrhosis, compensated cirrhosis, acute-on-chronic liver failure, portal hypertension, bacterial translocation, systemic inflammation, hyperdynamic circulation, mortality risk, prognosis
- MeSH terms
- Humans, Liver Cirrhosis, Prognosis, Disease Progression, Risk Assessment
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