Prognostic Factors in Compensated and Decompensated Cirrhosis

There are an increasing number of studies that evaluate predictive factors, mostly of death, in cirrhosis. These are different depending on the presence of compensated or decompensated cirrhosis. In compensated cirrhosis the main event to predict is decompensation. The degree of portal hypertension as determined by the hepatic venous pressure gradient (HVPG) and serum albumin levels are the most relevant predictors of decompensation. Since HVPG determination is obtained through an invasive procedure, recent studies have examined alternative non-invasive methods to establish the presence of clinically significant portal hypertension. In decompensated cirrhosis the main event to predict is death and “further decompensation”, the event that most commonly occurs prior to death. The Child and MELD scores are the most important predictors of death in decompensated disease. Child score continues to be a useful stratifying tool in all patients with cirrhosis. Specific predictive factors in each type of clinical decompensation are discussed.