Concept of Further Decompensation and Recompensation

The natural history of cirrhosis is characterized by two main clinical stages: a long, asymptomatic stage (compensated cirrhosis) with a median survival that exceeds 12 years and a symptomatic stage (decompensated cirrhosis) with a median survival of ~1-2 years. Among decompensating events, ascites are the most common, occurring in about two-thirds of cases, followed by variceal hemorrhage and then hepatic encephalopathy, with the least common being isolated jaundice (D’Amico et al., Aliment Pharmacol Ther 39:1180–93, 2014). A stage of “further” decompensation has been defined empirically as a stage with higher mortality than even that of decompensated cirrhosis but this has not been entirely supported by evidence.