What is cirrhosis, and what distinguishes compensated from decompensated cirrhosis?

Cirrhosis is diffuse hepatic fibrosis with conversion of normal architecture into regenerative nodules, the irreversible end-stage of chronic liver injury. Compensated cirrhosis is asymptomatic with preserved function; decompensated cirrhosis shows overt features - jaundice, ascites, variceal bleeding, hepatic encephalopathy, and renal dysfunction.

Clinical relevance. Distinguishing compensated from decompensated cirrhosis determines whether to focus on the cause or on managing complications.

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Cirrhosis: compensated vs decompensated

Cirrhosis is the common irreversible end-point of many chronic liver diseases, and its stage determines prognosis and management.

Definition

• Diffuse fibrosis with destruction of normal lobular architecture and formation of regenerative nodules.

Compensated cirrhosis

• Liver function is preserved; the patient is often asymptomatic and may lead a normal life.

Decompensated cirrhosis

• Marked by overt clinical signs: jaundice, ascites, variceal bleeding, hepatic encephalopathy, and renal dysfunction.
• Each episode of decompensation worsens prognosis.

Why the distinction matters

• Compensated patients need surveillance and treatment of the cause; decompensated patients need management of complications and consideration for transplantation.