Liver decompensation
Transition to decompensated cirrhosis↓
Also searched as Transition to decompensated cirrhosis.
You want to stay on the compensated side. And there is a way back: Baveno VII defines recompensation, which requires removing the cause.
In depth
Cirrhosis has two stages, and the border between them is an event, not a scan. Ascites, variceal bleeding, encephalopathy or jaundice - the first one to arrive marks the turn. A second event carries a higher mortality than the first.
What drives it
Portal pressure increases it.
10.1016/j.jhep.2021.12.022 — Verbatim (S1665268123002831): 'the appearance of variceal bleeding, ascites, hepatic encephalopathy OR non-obstructive jaundice, herald the onset of decompensated cirrhosis.'. doi 10.1016/j.jhep.2021.12.022
Abdominal fluid increases it.
Verbatim (pmc12453315, on the Baveno vii shift): 'this paradigm shifted from solely preventing variceal bleeding to preventing hepatic decompensation more broadly. This approach redefines decompensation as a whole, recognizing that any initial decompensating event, especially ascites (the most common), significantly worsens patient prognosis and can be prevented with therapy.'.
Swollen veins increases it.
10.1016/j.aohep.2023.101180 — verbatim (s1665268123002831): 'further decompensation should be considered as a new prognostic stage that carries a higher mortality than the one associated with the first decompensation event. the most frequent combination is variceal hemorrhage and ascites, with A 5-year mortality as high as 88%.'. doi 10.1016/j.aohep.2023.101180
Mental clarity in liver health increases it.
10.1016/j.jhep.2021.12.022 — Baveno vii (doi via s0168-8278(21)02299-6): 'Transition from the compensated to the decompensated stage is clinically marked by the development of complications such as ascites, variceal hemorrhage and overt hepatic encephalopathy.'. doi 10.1016/j.jhep.2021.12.022
Alcohol metabolism increases it.
10.1186/s12876-026-04651-6 — the edge that matters most to this blend, and it points at the exit. Baveno VII introduced recompensation, 'defined as at least partial regression of the structural and functional derangements of cirrhosis after removal of the underlying cause', and this cohort required all three of: '1) removal of the underlying etiology (i.e. abstinence from alcohol);' '2) resolution of ascites (without diuretics), HE (without lactulose/rifaximin), and VB' 'with no recurrence for at least 12 months'; and '3) sustained improvement in liver function, indicated by a Model for End-Stage Liver Disease (MELD) score < 10' 'and/or a Child-Pugh class A.' For alcoholic liver disease the underlying etiology is alcohol. Recompensation is defined as requiring its removal. No supplement replaces that step. doi 10.1186/s12876-026-04651-6
Blends that modulate it
Each blend page names this pathway and carries the study behind its claim.
See it on the map
Open the causal map to follow this pathway upstream and downstream, arrow by arrow, each with its study.