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©The Author(s) 2023.
World J Methodol. Sep 20, 2023; 13(4): 179-193
Published online Sep 20, 2023. doi: 10.5662/wjm.v13.i4.179
Published online Sep 20, 2023. doi: 10.5662/wjm.v13.i4.179
Table 1 Factors associated with decompensation of compensated liver cirrhosis
Risk factors for non-acute decompensation | Precipitating factors for acute decompensation |
Thick fibrous septa and micronodularity on liver biopsy | Bacterial infection |
Persistent liver injury by etiological factor | Active alcoholism |
High portal pressure | Gastrointestinal haemorrhage |
Systemic inflammation & hemodynamic changes | Consumption of hepatotoxic drug/alternative medicine |
Metabolic risk factors: DM, obesity, and dyslipidaemia | Superinfection or flare of viral hepatitis |
Genetic risk factors: PNPLA3 G/G genotype | Major surgery and general anaesthesia |
Table 2 Impact of etiological treatment on regression of liver cirrhosis
Ref. | Study design | Drug/duration | Patients, n | Baseline LC | Main results |
Dienstag et al[26], 2003 | Prospective, partially randomised | Lamivudin/3 yr | 63 CHB | 11 | LC regressed in 8 of 11 patients (73%) |
Hadziyannis et al[27], 2006 | Prospective | Adefovir dipivoxil, up to 240 wk | 125 CHB | 4 | 58% had reversal of bridging fibrosis/cirrhosis; 3 of 4 LC patients had reversal |
Marcellin et al[29], 2013 | Randomised trial | TDF/adefovir for 48 wk then open-label TDF | 641 CHB | 96 | 71 of 96 (74%) became non-cirrhotic at 5 yr |
Poynard et al[52], 2002 | Pooled data from RCTs | IFN/PEG-IFN + RBV | 3010 CHC | 153 | The reversal of LC was observed in 75 patients (49%) |
Mauro et al[53], 2018 | Retrospective | DAAs/IFN + RBV | 112 HCV-infected LT recipients | 37 | Regression of fibrosis in 43% of LC (16/37) |
Lassailly et al[55], 2020 | Prospective | Bariatric surgery | 180 obese NASH | 9 | At 5 yr, fibrosis regression was seen in 68% of advanced fibrosis and 33% of patients had reversal of LC |
Sanyal et al[54], 2022 | Data from two RCTs | Simtuzumab or selonsertib or placebo | 1135 NASH patients, 709 (62%) had Ishak stage 6 fibrosis | 709 | LC regression occurred in 16% (176/1135). Drugs were not better than placebo |
Dufour et al[64], 1997 | Retrospective | Immunosuppressant | 8 AIH cirrhosis | 8 | LC regressed in all |
Czaja et al[63], 2004 | Retrospective | Corticosteroid | 87 AIH | 14 | LC regressed in 4 of 14 patients |
Bardou-Jacquet et al[66], 2020 | Retrospective | Venesection | 106 patients with haemochromatosis | 66 | LC regressed in 15 of 66 (23%) during median follow-up of 9.5 yr |
Table 3 Impact of non-selective beta-blockers on portal hypertension, variceal haemorrhage, decompensation, and survival in patients with liver cirrhosis
Ref. | Study population | Intervention | Study design | Sample size, n | Study conclusion |
Poynard et al[70], 1991 | LC patients with oesophageal varices | Propranolol, nadolol vs placebo | Meta-analysis of 4 RCTs | 589 | Both propranolol and nadolol were effective in preventing first VH and reducing the mortality associated with VH |
Tripathi et al[71], 2009 | LC patients with grade II or more varices | Carvedilol vs EVL | RCT | 152 | On intention-to-treat analysis, carvedilol had lower rates of the first VH compared to EVL (10% vs 23%) |
Gluud et al[69], 2012 | LC patients with high-risk varices without prior VH | NSBBs vs EVL | Meta-analysis of 19 RCTs | 1504 | Both EVL and NSBB reduced VH (RR: 0.69 and 0.67) without difference in mortality rates |
Sinagra et al[75], 2014 | LC patients with PHT | Carvedilol vs propranolol | Meta-analysis of 5 studies | 175 | Carvedilol reduced PHT significantly more than propranolol |
Bhardwaj et al[76], 2017 | LC patients with small varices | Carvedilol vs placebo | RCT | 140 | Carvedilol is safe and effective in delaying the progression of small to large oesophageal varices in LC patients |
Zacharias et al[77], 2018 | Adults with LC and varices | NSBBs | Meta-analysis of 10 RCTs | 810 | Carvedilol was more effective at reducing the HVPG. However, it was not better than traditional NSBBs with regard to the mortality, VH, or adverse events |
Malandris et al[72], 2019 | LC patients requiring primary or secondary prevention of VH | Carvedilol, NSBBS, EVL | Meta-analysis of 13 RCTs | 1598 | Carvedilol was as efficacious and safe as standard-of-care interventions for the primary and secondary prevention of VH. Also, carvedilol was associated with lower all-cause mortality compared to EVL |
Sharma et al[73], 2019 | LC patients with large oesophageal varices and no prior history of VH | NSBB, isosorbide-mononitrate, carvedilol, and EVL alone or in combination | Meta-analysis of 32 RCTs | 3362 | NSBB monotherapy decreased all-cause mortality and the risk of first VH. Additionally, NSBB carried a lower risk of serious complications compared with EVL |
Villanueva et al[22], 2019 | CLC patients and CSPH | Propranolol, carvedilol vs placebo | RCT | 201 | Long-term treatment with β blockers could increase decompensation-free survival in patients with CLC with CSPH, mainly by reducing the incidence of ascites |
Villanueva et al[78], 2022 | LC patients with CSPH | Carvedilol vs EVL/no treatment | Meta-analysis of 4 RCTs | 352 | Long-term carvedilol therapy reduced decompensation and significantly improved survival |
- Citation: Kumar R, Kumar S, Prakash SS. Compensated liver cirrhosis: Natural course and disease-modifying strategies. World J Methodol 2023; 13(4): 179-193
- URL: https://www.wjgnet.com/2222-0682/full/v13/i4/179.htm
- DOI: https://dx.doi.org/10.5662/wjm.v13.i4.179