Liver Stiffness and Hepatic Decompensation

Abstract

Liver cirrhosis encompasses a huge variety of different dysfunctions, and better standardized classifications are required to categorize the various subtypes of cirrhosis. For instance, cirrhosis can present clinically as either liver failure (synthesis impairment) or complications of portal hypertension and both conditions can occur independently in cirrhotic patients and determine individual prognosis. These chains of thoughts suggest that better subgroups of liver cirrhosis should be defined in order to predict distinct complications in individual patients. For instance, the degree of synthesis impairment and portal hypertension should be evaluated separately to better determine the natural course, prognosis, potential complications, and therapeutic interventions. Accordingly, combined liver stiffness and spleen stiffness are excellent parameters to predict portal hypertension and its complications. A LS of 12 kPa can be considered as important significant cut-off values were various complications of decompensation are likely to occur at hazard ratios ranging from 4 to 6. Below 12 kPa, complications are very unlikely. In contrast, serum markers are ideal to assess the degree of liver failure. It has been recently hypothesized that hepatic vascularization (arterialization versus hepatic shunt formation) plays an important role in the development of these two major subtypes. At LS values >30 kPa, liver function markers such as albumin or bilirubin become more important to predict complications and liver failure within the 12 months range.