![]() In addition, the presence of decompensated cirrhosis can have major implications regarding management and prevention of cirrhosis-related complications, as well as the potential need for a referral for liver transplantation evaluation. Prognosis and survival are markedly better in persons with compensated cirrhosis than in those with decompensated cirrhosis ( Figure 1) and ( Figure 2). Distinguishing Compensated versus Decompensated Cirrhosis In contrast, persons with decompensated cirrhosis often have symptomatic complications related to cirrhosis, including those related to hepatic insufficiency (jaundice or hepatic encephalopathy), and those related to portal hypertension (ascites or variceal hemorrhage). Persons with compensated cirrhosis often do not have signs or symptoms related to their cirrhosis, although they may have evidence of portal hypertension, such as esophageal or gastric varices. Once it has been established that an individual has cirrhosis, it becomes very important to determine whether they have compensated or decompensated cirrhosis. Defining Compensated and Decompensated Cirrhosis As individuals develop more extensive hepatic fibrosis, physiologic complications can develop, such as increased pressure within the portal system, disruption in bilirubin metabolism, and reduced production of coagulation factor proteins. Advanced fibrosis and cirrhosis-at their early stages-are not usually clinically detectable or symptomatic. Research Blogging.In an estimated 20 to 30% of persons with hepatitis C virus (HCV) infection, chronic viremia results in inflammation, followed by fibrosis and cirrhosis. "MELD-XI: a rational approach to "sickest first" liver transplantation in cirrhotic patients requiring anticoagulant therapy". ↑ Heuman DM, Mihas AA, Habib A, et al."Model for end-stage liver disease score to serum sodium ratio index as a prognostic predictor and its correlation with portal pressure in patients with liver cirrhosis". "Evidence-based incorporation of serum sodium concentration into MELD". ↑ Biggins SW, Kim WR, Terrault NA, et al."An integrated MELD model including serum sodium and age improves the prediction of early mortality in patients with cirrhosis". ↑ Luca A, Angermayr B, Bertolini G, et al."Predicting outcome after cardiac surgery in patients with cirrhosis: a comparison of Child-Pugh and MELD scores". ↑ Suman A, Barnes DS, Zein NN, Levinthal GN, Connor JT, Carey WD (August 2004)."Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients". ↑ Farnsworth N, Fagan SP, Berger DH, Awad SS (November 2004)."Risk factors for mortality after surgery in patients with cirrhosis". ↑ Teh SH, Nagorney DM, Stevens SR, et al (April 2007)."A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts". ↑ Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC (2000)."A model to predict survival in patients with end-stage liver disease". ↑ Kamath PS, Wiesner RH, Malinchoc M, et al (2001)."Hyponatremia and mortality among patients on the liver-transplant waiting list". ↑ Kim WR, Biggins SW, Kremers WK, et al (September 2008).MELD = 6.43 + 3.78 × ln ( bilirubin mg/dL ) + 9.57 × ln ( creatinine mg/dl ) + 11.2 × ln ( INR ) References The MELD Score ( Model for End-Stage Liver Disease Score) can help predict mortality in patients with cirrhosis and end-stage liver disease.
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