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Defining Clinical Hints to Predict Decompensation and Altering Paradigm in Patients with Cirrhosis

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Portal Hypertension VI

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Abstract

Prognosis in cirrhosis is highly variable depending on the stage, with one-year mortality ranging from 1 to 57 %. Clinicians therefore should focus on an early diagnosis of advanced liver disease before decompensation occurs. Noninvasive fibrosis tests, such as transient elastography, together with hepatic venous pressure gradient (HVPG) and quantitative fibrosis assessment using CPA, can be used to subclassify patients with cirrhosis and predict clinical decompensation. HVPG values above 10 mmHg and/or transient elastography values >20 KPa are associated with increased risk of decompensation. The management of patients with cirrhosis should therefore change to preventing the advent of all complications while in the compensated phase. Safe, widely available, and relatively inexpensive treatment regimens seem to have beneficial effects on reduction of portal pressure, prevention of complications, regression of fibrosis, and improvement in survival. Such drugs include b-blockers, statins, metformin, nonabsorbable antibiotics, and anticoagulants either alone or in combination. The potential effect of these drugs should be investigated in phase III randomized controlled trials. In the current era, cirrhosis should be regarded as treatable and potentially reversible with currently available therapy and not an irreversible disease that leads inevitably to liver transplantation or death.

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Authors and Affiliations

  1. UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, Pond Street, London, NW3 2QG, UK

    Maria Kalafateli & Emmanuel A. Tsochatzis

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  1. Maria Kalafateli
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  2. Emmanuel A. Tsochatzis
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Correspondence to Emmanuel A. Tsochatzis .

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  1. Gastroenterology Unit, Luigi Sacco University Hospital, Milan, Italy

    Roberto de Franchis

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Kalafateli, M., Tsochatzis, E.A. (2016). Defining Clinical Hints to Predict Decompensation and Altering Paradigm in Patients with Cirrhosis. In: de Franchis, R. (eds) Portal Hypertension VI. Springer, Cham. https://doi.org/10.1007/978-3-319-23018-4_11

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  • DOI: https://doi.org/10.1007/978-3-319-23018-4_11

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23017-7

  • Online ISBN: 978-3-319-23018-4

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