Major Complications and Causes of Mortality
Complications of liver cirrhosis determine the patient's severity and directly lead to death. Key life-threatening conditions include:
- Liver failure.
- Hepatic encephalopathy and its extreme degree — coma.
- Massive bleeding. The source is most frequently varices of the esophagus, stomach, or intestines.
- Thrombosis in the portal venous system.
- Hepatorenal syndrome.
- Development of hepatocellular carcinoma (HCC). Transformation into cancer, for example, in alcoholic etiology, occurs with a frequency of 5–15%.
Infectious complications, which are particularly characteristic of alcoholic liver disease, are distinguished separately. These include pneumonia, sepsis, and spontaneous bacterial peritonitis (arising secondary to ascites). Hemorrhage, coma, thrombosis, and secondary infections constitute the primary mortality profile in this disease.
Morphological Markers of Process Activity
Disease activity is assessed by clinical, biochemical, and histological criteria. It is important to remember that any activation of the process inevitably leads to its decompensation. The morphological picture of the active phase is characterized by the predominance of destruction:
- Necrosis: a large number of bridging, confluent, spotty, and piecemeal necroses are identified in the tissue.
- Dystrophy: hepatocytes undergo marked hydropic and ballooning degeneration.
- Inflammation: focal or diffuse lymphohistiocytic infiltrates form. They localize both within pseudolobules and in fibrous septa.
- Structural remodeling: specific hepatocyte "rosettes" appear, and hepatic trabeculae thicken as a result of regeneration. New connective tissue septa form, further fragmenting pseudolobules into smaller pieces.
Prognosis and Survival
Prognosis directly depends on etiology, liver functional status, and the presence of complications. Overall 5-year survival is 70–75%, and functional compensation is possible even at advanced stages. However, with decompensation, only 11–40% of patients are alive at 3 years. The appearance of ascites limits life expectancy to 3–5 years.
Prognosis varies greatly depending on the underlying cause:
- Hepatitis B virus (HBV): 5-year survival reaches approximately 55% (up to 70% in asymptomatic inactive courses). The main causes of death are liver failure (80%) and HCC (40%). Superinfection with hepatitis delta virus (HDV) sharply worsens the prognosis.
- Hepatitis C virus (HCV): progression is slow, and the prognosis is often indeterminate. Annual mortality is 2–5%, and the tumor development rate is 3–4% per year.
- Alcoholic liver disease: average survival is 5 years. Complete abstinence can prolong life, but this effect is significant only in early stages, prior to the onset of refractory ascites and bleeding.
Traditionally, cirrhosis is considered an irreversible condition, but there is evidence of potential regression of fibrous septa (particularly in hemochromatosis).