Transition to decompensation and acute-on-chronic liver failure: Role of predisposing factors and precipitating events

The transition from compensated to decompensated cirrhosis results from a complex interplay of predisposing and precipitating factors and represents an inflection point in the probability of a patient surviving. With the progression of cirrhosis, patients accumulate multiple disorders (e.g. altered liver architecture, portal hypertension, local and systemic inflammation, bacterial translocation, gut dysbiosis, kidney vasoconstriction) that predispose them to decompensation. On the background of these factors, precipitating events (e.g. bacterial infection, alcoholic hepatitis, variceal haemorrhage, drug-induced liver injury, flare of liver disease) lead to acute decompensation (ascites, hepatic encephalopathy, variceal bleeding, jaundice) and/or organ failures, which characterise acute-on-chronic liver failure. In this review paper, we will discuss the current hypotheses and latest evidences regarding predisposing and precipitating factors associated with the transition to decompensated liver disease. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Automated summary

The transition from compensated to decompensated cirrhosis is a critical point in the probability of patient survival, influenced by a complex interplay of factors. As cirrhosis progresses, patients accumulate multiple disorders, predisposing them to decompensation, which is triggered by precipitating events leading to acute decompensation like ascites, hepatic encephalopathy, variceal bleeding, and jaundice.