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Acute Complications of Cirrhosis Masterclass by Sarah Kessler, PharmD, BCPS, BCGP

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  • Severe, chronic, progressive fibrosis due to chronic injury, leading to liver failure and associated complications
  • 11th leading cause of death of adults in the United States in 2020
    • 4.5 million adults diagnosed with liver disease (1.8% of the population)
    • Likely an underestimation of the burden of disease

Epidemiology & Health Disparities

  • Most common causes in the US:
    • Alcohol Use Disorder
    • Viral Hepatitis (Hepatitis B and C)
    • Fatty Liver Disease
      • Nonalcoholic steatohepatitis (NASH)
      • Nonalcoholic fatty liver disease (NAFLD)
  • These causes account for approximately 80% of the patients on the liver transplant waitlist between 2003-2014
    • Second longest organ waitlist in the United States (second to kidney transplantation)

Additional Causes

  • Infection
  • Autoimmune
  • Hemochromatosis
  • Medications

Categorizing Cirrhosis


  • Much higher in those with cirrhosis
    • 26.4% per two-year interval in those with cirrhosis versus 8.4% in propensity-matched controls
  • Significant differences when comparing compensated and decompensated cirrhosis
    • Risk of death:
      • Compensated: 4.7 times higher than the general population
      • Decompensated: 9.7 times higher than the general population
    • Life expectancy:
      • Compensated: 10-13 years
      • Decompensated: as little as 2 years

Financial Burden

  • Continuing to rise due to cirrhosis and associated complications requiring hospitalization
    • Estimated direct and indirect costs to be in the billions
    • As hospitalizations go up, so does the cost burden on the healthcare system
  • Extended length of stay, medications, and need for emergent procedures all increase cost in this patient population
  • Chronic liver disease patients have also been shown to have
    • Longer admissions
    • More readmissions
    • Less access to care than in other disease states

Pathophysiology Overview