Overview: In an estimated 20 to 30% of patients with hepatitis C infection, chronic viremia results in inflammation followed by fibrosis and cirrhosis. Advanced fibrosis and early cirrhosis are not usually clinically detectable or symptomatic. As patients develop more extensive hepatic fibrosis, pressure begins to build within the portal system, potentially resulting in development of esophageal varices and splenic sequestration of platelets.
Defining Compensated versus Decompensated Cirrhosis: Once it has been established that a patient has cirrhosis, it becomes very important to determine whether they have compensated or decompensated cirrhosis. Patients with compensated cirrhosis do not have symptoms related to their cirrhosis, but may have asymptomatic esophageal or gastric varices. Patients with decompensated cirrhosis have symptomatic complications related to cirrhosis, including those related to hepatic insufficiency (jaundice), and those related to portal hypertension (ascites, variceal hemorrhage, or hepatic encephalopathy).
Importance of Distinguishing Compensated versus Decompensated Cirrhosis: Prognosis and survival is markedly better in patients with compensated cirrhosis than in those with decompensated cirrhosis (Figure 1). In addition, determining that a patient has decompensated cirrhosis can have major implications regarding management and prevention of cirrhosis-related complications, as well as consideration for a referral for liver transplantation evaluation. In general, any patient with decompensated cirrhosis should receive evaluation and medical care by a hepatologist. Some experts have proposed a 4-stage cirrhosis classification system that encompasses the spectrum of compensated and decompensated disease (Figure 2).