The liver can still function with up to 80 percent deterioration

The liver can still function with up to 80 percent deterioration

In hepatitis C infection about 20 percent of people develop cirrhosis. Once your liver has reached this stage cirrhosis commonly occurs in two stages, compensated and decompensated. In the first stage of liver damage, the liver still has the ability to function normally or compensate for the damage. When extensive damage occurs and the liver can no longer function normally, decompensation occurs. According to the Hepatitis C Trust, up to 80 to 90 percent of the liver becomes permanently damaged before decompensated occurs.

Decompensated cirrhosis

Decompensated cirrhosis is the final stage of the hepatitis C cycle that relates to liver damage. It is usually at this point that there is a significant risk of life threatening complications. The liver at this stage will be covered with nodules and shrunken in size. Once decompensated cirrhosis is established there is usually a very high frequency of readmissions to hospital. There is also a strong likelihood of developing complications or illness additional to the initial complication.

Because the liver is crucial for so many metabolic activities, cirrhosis impacts on a wide range of the body's functions, including nutrient and hormone metabolism, blood clotting, and processing of ammonia and other toxic wastes. Many of the symptoms of decompensated cirrhosis are directly related to disruption of these functions. So resilient is the liver that it only finally fails when about 80-90% of the liver is seriously damaged but with decompensated cirrhosis this stage is close at hand.

Compensated cirrhosis.

Cirrhosis is a description of the extent of scarring of the liver. With cirrhosis, scarring or fibrosis has advanced to the extent that the structure of the liver is altered: the usual smooth texture of the liver starts to become nodular and lumpy. Nodules are areas of liver cells that have become cut off from the rest of the liver by circular bands of scarring with liver cells unsuccessfully trying to regenerate inside the bands. The free flow of blood throughout the liver starts to be compromised.

Compensated cirrhosis means that the liver is still able to cope with or compensate for the damage and carry out most (sometimes all) of its functions. Cirrhosis, as with fibrosis, ranges from mild (at the beginning) to moderate and severe. Severe cirrhosis can then progress to decompensated cirrhosis. The rate of progression of cirrhosis is different in different people but is not apparently related to genotype. Progression is effected by similar factors to fibrosis but at this stage the effect of alcohol on liver damage is even greater.

Many people do not experience symptoms once they have developed compensated cirrhosis that differ from those they may have had during the chronic phase of the disease. Many people experience no symptoms at all. In general people with well-compensated cirrhosis have normal liver function for serum albumin, clotting factors and bilirubin and even sometimes normal liver enzymes. There is also no evidence of portal hypertension. But over time without treatment compensated cirrhosis does seem to progress inevitably to decompensated cirrhosis. For some people this may take many years and they may well die from other unrelated causes before that time. From the studies so far it appears that on average 18% of people with compensated cirrhosis will progress to decompensated cirrhosis after 5 years and that after ten years the rate will be 29%.

.As with the chronic stage of hepatitis C peoples experiences and symptoms during compensated cirrhosis will vary significantly.

.The following is a list of symptoms that are more specifically associated with compensated cirrhosis, (and this can be on top of any of the other symptoms that can be experienced with hepatitis C). It doesn't mean however that you will necessarily experience them or that if you do, that it means you have cirrhosis.

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General Symptoms

Tiredness and weakness (This may result from insufficient nutrients being processed by the liver)

Loss of appetite.

Nausea and vomiting.

A build-up of fluid in the legs and abdomen.

Weight loss.

The tendency to bruise easily.

Jaundice (yellowing of the skin and the white of the eyes).

Itchiness.

Sensitivity to drugs due to reduced ability of the liver to inactivate them

Spider nevi. These are small capillaries that are seen on the surface of your skin. Branches grow from the one capillary and it can either look like a small red spider or a splat (kind of like a squashed spider. They can be found only above the waist, usually on the chest, upper arms, shoulders, face, neck and upper back.

Research

Healio Summary 

Novel score predicts DAA benefit in patients with HCV, decompensated cirrhosis
March 21, 2018
Researchers have developed a predictive score that quantifies the potential benefits of direct-acting antiviral therapy for patients with hepatitis C…

Study

Baseline Factors Associated with Improvements in Decompensated Cirrhosis After Direct-acting Antiviral Therapy for HCV Infection.

We identified 5 baseline factors (BMI, encephalopathy, ascites, and serum levels of ALT and albumin) associated with a reduction of CPT score to class A in patients with HCV-associated decompensated cirrhosis receiving DAA therapy. We developed a predictive score using these factors, called the BE3A score, that can be used as a shared decision making tool, quantifying the potential benefits of DAA therapy for patients with decompensated cirrhosis.

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