What is the Difference Between Compensated and Decompensated Liver Cirrhosis

The key difference between compensated and decompensated liver cirrhosis is that compensated liver cirrhosis is the asymptomatic stage of liver cirrhosis, while decompensated liver cirrhosis is the symptomatic stage of liver cirrhosis.

Liver cirrhosis causes the gradual replacement of healthy liver cells with scar tissues. Cirrhosis normally happens over a long period of time due to infections or alcohol addiction. Cirrhosis is the end stage of any chronic liver disease. There are two different clinical stages of cirrhosis as compensated and decompensated. Compensated liver cirrhosis is the initial stage, while decompensated liver cirrhosis is the more complicated stage.

1. Overview and Key Difference
2. What is Compensated Liver Cirrhosis
3. What is Decompensated Liver Cirrhosis
4. Similarities – Compensated and Decompensated Liver Cirrhosis
5. Compensated vs Decompensated Liver Cirrhosis in Tabular Form
6. Summary – Compensated vs Decompensated Liver Cirrhosis

What is Compensated Liver Cirrhosis?

Compensated liver cirrhosis is the asymptomatic stage of liver cirrhosis. If someone has compensated cirrhosis, they won’t show any symptoms. But in rare cases, some symptoms like itching, fatigue, loss of appetite, stomach, weight loss, bruising, swelling/retaining fluid in the legs or abdominal area, confusion, and loss of muscle mass come out. At this stage, the liver still carries out its function because there are healthy cells to take up for the damaged cells and scar tissues caused by cirrhosis. Therefore, people who are suffering from compensated liver cirrhosis can stay in this stage for many years. A more complicated stage called decompensated cirrhosis comes after compensated cirrhosis. However, there is potential reversibility from decompensated to the compensated stage.

The presence of varices is the key prognostic factor for compensated patients and indicates a higher likelihood of decompensation. Moreover, the median survival time of patients with compensated cirrhosis is > 12 years. The diagnosis of compensated liver cirrhosis is more challenging as patients may lack clinical, laboratory, and radiologic findings. They may require a biopsy for diagnosis.

The management option for compensated liver cirrhosis may include treatment for underlying conditions (antiviral treatment for HBV and HCV, abstinence from alcohol), screening for varices (prevention of varices haemorrhage), screening for hepatocellular carcinoma, and prevention of decompensation (complete alcohol abstinence, obesity management, careful dosing and selection of drugs, appropriate vaccination, not avoiding statins, optimizing control of diabetes mellitus).

What is Decompensated Liver Cirrhosis?

Decompensated liver cirrhosis is the symptomatic stage of liver cirrhosis. Cirrhosis normally does not show any symptoms at the earlier stages. However, as it progresses to decompensated liver cirrhosis, it can cause symptoms such as jaundice, fatigue, weight loss, easy bleeding and bruising, bloated abdomen due to fluid accumulation, swollen legs, confusion, slurred speech or drowsiness, nausea, loss of appetite, spider veins, redness on the palms of the hands, shrinking testicles, breast growth in men, and unexplained itchiness. The diagnosis of decompensated liver cirrhosis is easier and can be performed through patient history, physical examination, imaging tests (CT scan, MRI, and ultrasound), and laboratory findings (blood tests).

The management option for decompensated liver cirrhosis may include following a low salt diet, not using recreational drugs or alcohol, taking diuretics, taking antiviral medication to manage chronic hepatitis B or C, limiting the fluid intake, taking antibiotics to treat any underlying infections or prevent new ones, taking medicines to improve the flow of blood to the liver, screening for varices (prevention of varices haemorrhage), screening for hepatocellular carcinoma, ascites (taking diuretics), encephalopathy (use of lactulose or rifaximin), prevention of further decompensation and death, prevention of recurrent variceal hemorrhage (beta-blockers and ligation), liver transplant and other tips for recurrent symptoms (complete abstinence of alcohol, obesity management, careful dosing and selection of medicines, appropriate vaccinations, vasodilators, avoidance of NSAIDs, using lower doses of statins, optimize control of diabetes mellitus).

What are the Similarities Between Compensated and Decompensated Liver Cirrhosis?

Compensated and decompensated liver cirrhosis are the two main stages of liver cirrhosis.
The causes for both liver cirrhosis stages are the same.
Scar tissue replacing normal liver cells can be observed in both stages of liver cirrhosis.
Both stages of liver cirrhosis can be managed by antiviral treatment and alcohol abstinence.

What is the Difference Between Compensated and Decompensated Liver Cirrhosis?

Compensated liver cirrhosis is the asymptomatic stage of liver cirrhosis, while decompensated liver cirrhosis is the symptomatic stage of liver cirrhosis. Thus, this is the key difference between compensated and decompensated liver cirrhosis. Furthermore, the median survival time of patients with compensated cirrhosis is > 12 years, while the median survival time of patients with decompensated cirrhosis is approximately 2 years.

The below infographic presents the differences between compensated and decompensated liver cirrhosis in tabular form for side-by-side comparison.

Summary – Compensated vs Decompensated Liver Cirrhosis

Cirrhosis is the scarring of the liver due to long-time liver damage. Compensated and decompensated liver cirrhosis are two stages of liver cirrhosis disease. Compensated liver cirrhosis refers to the asymptomatic stage of liver cirrhosis, while decompensated liver cirrhosis refers to the symptomatic stage of liver cirrhosis. So, this is the key difference between compensated and decompensated liver cirrhosis.

Reference:

1. Welch, Connie M. “What Is Compensated and Decompensated Cirrhosis?” Hep, 9 Dec. 2020.
2. Osborn, Corinne O’Keefe. “Decompensated Cirrhosis: Symptoms, Causes, Treatment, Life Expectancy.” Healthline, Healthline Media, 30 July 2018.

Image Courtesy:

1. “NAFLD liver progression” By Signimu – Own work (CC BY-SA 3.0) via Commons Wikimedia
2. “Depiction of a person suffering from liver disease” By Myupchar (CC BY-SA 4.0) via Commons Wikimedia