Liver Cirrhosis

Key points

  • Volume replacement after large-volume paracentesis is recommended by clinical guidelines, to prevent post-paracentesis circulatory dysfunction
  • Albumin performs better than other volume expanders or vasoconstrictors
  • Long-term HA may have benefit in refractory ascites, but further research is needed
  • A trial of TIPS in refractory ascites resulted in better 1-year survival versus LVP and albumin

The most common complication of liver cirrhosis is ascites, with other hepatic complications being hepatic encephalopathy and variceal haemorrhage (Runyon et al., 2009; Runyon, 2012). The development of ascites is associated with a poor prognosis, with 5-year survival of around 40% (Bernardi et al., 2014).

Patients with cirrhosis and ascites are at high risk for other complications of liver disease, including refractory ascites, spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS) and hyponatraemia (European Association for the Study of the Liver, 2010).

The figure below summarises the main pathophysiological events and complications of cirrhosis (Bernardi et al., 2014).

Outline of the main pathophysiological events and complications of cirrhosis resulting in ascites, hyponatraemia, hepatorenal syndrome and multiorgan failure (MOF).

Outline of the main pathophysiological events and complications of cirrhosis resulting in ascites, hyponatraemia, hepatorenal syndrome and multiorgan failure (MOF) (Bernardi et al., 2014). Key: CO = carbon monoxide; PGI2 = prostaglandin I2 (prostacyclin)⁺; MOF = multiorgan failure ; Na+ = sodium ion; NO = nitric oxide.

A study of 309 patients with cirrhosis found that 75.4% (n=233) had evidence of ascites. A bacterial infection was diagnosed in 44.6% of patients with cirrhosis and ascites (n=104), with the bacterial infection associated with renal failure in around a third of patients (33.6%; n=35) (Fasolato et al., 2007). In cirrhotic patients with spontaneous bacterial peritonitis renal failure is a risk factor for mortality (Navasa et al., 1998).