Decompensated Liver Disease Life Expectancy: 10 Years (ICD-10)
The life expectancy of patients with decompensated liver disease varies from 5 years to 20 years. The average life span is between 8 and 12 years [1].
In general, the longer the time since diagnosis, the better the prognosis. However, some patients may have a good prognosis even if they had been diagnosed many months or even years before their death.
There are several factors which influence the life expectancy of patients with decompensated liver disease. These include age at onset, severity of liver damage, type and extent of hepatic fibrosis, presence or absence of cirrhosis, and other underlying diseases such as diabetes mellitus.
Age at Diagnosis: Patients with severe liver injury usually develop symptoms later than those with milder injuries. Therefore, it is not surprising that the median age at diagnosis ranges from 50 to 60 years [2].
Severity of Liver Injury: Severe liver injury occurs when there is extensive scarring of the liver. A patient with this degree of liver damage will need long-term care and may require dialysis. Milder forms of liver injury do not result in significant scarring and may be treated with antibiotics or supportive therapy.
Type and Extent of Liver Fibrosis: After the liver is damaged there is scarring or “fibrosis” that occurs in an attempt to heal the injury. There are varying degrees of fibrosis. It may be focal, meaning only a portion of the liver is affected, or generalized, meaning that the entire liver is involved. The extent of liver damage may also be described as “compensated” or “decompensated”.
When the liver has a few areas of fibrosis, it is “compensated”, meaning that it can still function at a normal level. With more extensive liver damage, the liver is “decompensated”, meaning that it is unable to perform its normal functions. In this situation the patient will have symptoms and signs of liver disease.
Cirrhosis: Cirrhosis is the final outcome of liver disease. It is characterized by extensive fibrosis that has replaced most of the liver’s functional tissue. The only remaining functional units are the portal triad (a group of blood vessels and glands located at the edge of the liver) and scattered areas of functioning liver cells located near the outer edge of the organ.
Progressive fibrosis leads to swelling, hardening and loss of function of the liver. Patients with cirrhosis are at high risk of developing liver cancer.
Other Underlying Diseases: Having other serious diseases can have a negative effect on the liver. Diseases such as heart failure, kidney failure, low blood counts and malnutrition can all have an impact on survival. Patients with poorly controlled diabetes may develop diabetic complications of the kidneys (diabetic nephropathy), eyes (diabetic retinopathy) or blood vessels (diabetic angiopathy). These complications may lead to end-stage kidney disease, blindness and/or severe claudication, respectively.
Treatment
There is no known way to reverse the underlying cause of this disease, which is ultimately damage to liver cells. In patients with alcoholic liver damage, stopping alcohol consumption is essential.
Several treatment options are available for patients with this condition.
Liver transplantation is the only potential cure for this condition. Patients who are severely ill from liver damage may need a liver transplant to survive. The severity of liver disease alone does not necessarily predict who will benefit from a liver transplant; a patient’s other underlying medical conditions also have to be taken into consideration.
Some patients with liver disease don’t qualify for a liver transplant, or they may need to wait months before a donor organ becomes available. In these patients, a liver transplant is not an immediate treatment option.
In some cases of liver disease, a liver transplant may be done even if the underlying condition is not life-threatening, such as in patients with alcoholic cirrhosis. In these cases, patients are screened to make sure they are willing and able to take care of their health after the transplant, and to lessen the chance that the transplant will be rejected. The patient’s alcohol use is stopped or strictly controlled. Immunosuppressive therapy is also given to patients after the transplant to decrease the chance of rejection or of forming antibodies that can attack the transplanted liver.
In patients with fatty (hepatic) liver degeneration, weight reduction and increased physical activity may slow the progression of disease. Patients with alcoholic liver damage may benefit from counseling to stop alcohol consumption.
Other therapies for nonviral liver disease are based on the specific disease causing the cirrhosis. Patients with toxic liver disease may benefit from giving up alcohol in favor of an antiviral medication to help their immune system. Patients with autoimmune hepatitis may benefit from steroids to decrease inflammation in the liver.
Research has shown that individuals who have experienced a prior episode of acute hepatitis have an increased risk of developing liver cancer and/or liver disease later in life.
A vaccine to prevent hepatitis A may be given if an individual is at high risk of infection. The vaccine is between 93% and 99% effective in preventing the disease. It is only given to individuals who have a high risk of infection, such as men who have sexual contact with other men, people who use injection and non-injection drugs, people with clotting factor disorders, people who work with animals (particularly reptiles), patients who receive a liver or kidney transplant, people working in healthcare, and people who regularly have close personal contact with someone with hepatitis A. Because the vaccine contains a small amount of inactivated virus it cannot give someone hepatitis A.
The vaccines to prevent hepatitis B are between 95% and 100% effective in children. They are given in three doses, and protection lasts at least twenty years. A booster dose every ten years may be necessary for long-term protection. In adults, the vaccine is between 70% and 95% effective in preventing the disease. Those who are vaccinated still have the ability to transmit the disease.
Hepatitis B vaccination is recommended for all infants, and is also recommended for other high-risk groups including people who have diabetes, people who use injection drugs, people who have intimate sexual contact with more than one partner (male or female), health care workers, people who change needles often, and people who travel to areas of the world where there is a higher risk of infection.
The vaccine to prevent hepatitis E is not effective in most people and therefore is not routinely recommended.
The only medications used for the treatment of viral hepatitis are those for the treatment of symptoms. People with hepatitis should rest, eat foods that build up the blood (such as meats), and avoid alcohol and caffeine. Over-the-counter medications such as pain killers (paracetamol) or other medicines such as antacids, are safe to take if necessary.
Liver transplants are often required for people with liver cancer or acute liver failure. In countries with good health care facilities, 10-year survival rates for liver transplant recipients are between 65% and 85%.
After the transplant, people are still infectious and can still transmit the disease to others. However, it is possible with antiviral medicines to suppress the virus in the transplanted liver and allow the liver to function again. The medicines work by suppressing viral replication and making it difficult for the virus to overcome the immuno-suppressed state of the patient.
There are no vaccines against hepatitis D or E. The best way to avoid them is to avoid contact with contaminated blood.
The World Health Organization (WHO) has programs to monitor the incidence of viral hepatitis globally and to increase awareness of the diseases. In 1992, WHO created the Hepatitis Prevention and Control Initiative to help create prevention and treatment programs globally. Many countries have national programs, such as the National Viral Hepatitis Prevention Program in the United States and the NHS Viral Hepatitis Programme in the United Kingdom.
Hepatitis A is a preventable disease.
The best way to prevent hepatitis A is to get vaccinated.
A vaccine has been available since 1995 and is usually given in two doses six months apart.
It is very contagious and can be spread when an infected person doesn’t wash their hands properly, especially after going to the toilet. The virus can also survive outside the body for up to two hours, or longer in cool humid conditions.
It cannot be caught from someone who has been recently vaccinated, the immuno-compromised (such as people with HIV) or people who have had the disease in the past.
There is no specific treatment for hepatitis A other than helping symptoms, such as rest and drinking plenty of fluids.
It can take up to a year for the liver to heal completely.
The vaccine lasts for ten years and a booster is given every ten years after that.
Hepatitis B is also a preventable disease.
In the 1970s, a vaccine was developed that lasts for life and is very effective at preventing people from getting infected by hepatitis B.
The vaccine is usually given in three doses over a period of time.
There is no specific treatment for hepatitis B. People with the disease are monitored, treatments are given for people with complications and supportive care is given, such as bed rest, medications and diet advice.
Hepatitis C can be prevented by not having blood-to-blood contact. This includes
Also avoiding IV drug use and tattoos.
Self-injection of illegal drugs can also be a risk factor for hepatitis C as sharing needles can result in the disease.
The vaccine for hepatitis A does not provide protection against hepatitis C.
There is no vaccine that can prevent hepatitis E infection.
Washing your hands after going to the toilet and before preparing food can reduce the risk of getting hepatitis A. Also, avoid contact with human faeces.
Practice safe tattooing and piercing by making sure the equipment has been sterilized.
Hepatitis D is usually only caught by people who are already infected with hepatitis B. This is because the main way of catching hepatitis D is through having sexual contact or sharing needles with someone who is infected with both viruses (a carrier). It is possible to be infected with hepatitis D without having either hepatitis A or B.
Relatively few people are carriers of hepatitis D.
Hepatitis E is prevented by not having blood-to-blood contact. This includes
Also avoiding eating pork and wild game such as deer or bears that have been infected with the virus.
No vaccines exist to prevent any type of hepatitis.
There is no cure for hepatitis, although some treatments can improve symptoms and allow the liver to heal itself over time. Medications such as NAC may be used to help reduce liver inflammation and ease nausea and fatigue.
While there is no vaccine for hepatitis E, the risk of getting it can be reduced by avoiding eating pork and wild game such as deer or bears that have been infected with the virus.
There are three main types of treatment available: medication, lifestyle changes, and transplant.
Medication can be taken as an injection or orally. Many people feel better within a few weeks of starting treatment. Medications can help the liver start working normally again and improve liver function tests.
Lifestyle changes such as getting rid of toxins in the house, stopping drinking alcohol, and losing weight if needed can be beneficial in many cases of hepatitis.
Most people with hepatitis will recover on their own and not need any treatment. This can happen within a few weeks to several months. Most people with hepatitis will have normal liver function within two years.
A liver transplant is usually only used in cases of cirrhosis due to hepatitis C or acute liver failure. In these specific cases, a liver transplant has a high success rate.
Hepatitis affects nearly quarter of the world’s population and more than 500 million people are infected with it. The disease causes nearly 1.5 million deaths per year.
Hepatitis A is most common in developing countries with poor sanitation, both among children and adults. In the United States, young adults have the highest infection rate.
Hepatitis A rates have been rising in the U.S. since 2013. Outbreaks in California, Pennsylvania, and Texas have contributed to this increase. In 2016, California experienced an outbreak of hepatitis A cases linked to scallions from one grower.
As of September 2017, there have been more than 540 cases reported in the state with the outbreak being concentrated in San Diego. Outbreaks have also occurred in Pennsylvania and Texas, and have been linked to food handlers with the virus and poor sanitation practices at food facilities.
Hepatitis B is most common in Africa, Asia, the Middle East, Eastern Europe, Central and South America. The disease is less common throughout the rest of the world including the United States. In the U.S., Asians have the highest rates of infection, followed by Native Americans and Pacific Islanders have the highest rates in the Western world.
In Africa, hepatitis B is more common in nomadic populations that have sexual relations with other tribes.
Hepatitis C is now more common than hepatitis B, and is most common among drug users and people who received blood transfusions before testing of blood supplies was required. However, hepatitis C is more difficult to catch than hepatitis A or B viruses. It is not spread through food, water, or the air. The virus can only live outside the body for a short time before dying. It is spread only through direct contact with infected blood.
Most often, this happens through sharing needles, syringes, or other drug preparation equipment. It is possible to catch the virus by getting scratched or cut while handling the equipment after an infected person has used it.
Once hepatitis becomes chronic, the symptoms fade and most people feel normal again. However, liver damage will continue until the disease can be halted or cured. In some cases, this will result in liver failure or cancer.
The disease is diagnosed by liver function tests, which are part of a standard blood test. If the numbers are abnormal, further testing will be required to determine if hepatitis is present.
Chronic hepatitis does not have any approved medications for the treatment. Instead, doctors sometimes use standard treatments for clearing out the liver and helping it regenerate.
Drugs such as Interferon and Ribavirin are sometimes used, but they also have severe side effects.
Liver transplants are sometimes used in cases of acute liver failure.
The only way to prevent hepatitis is through vaccination. There are vaccines for both types of hepatitis A and B. The vaccine can be received from a healthcare professional or purchased from a pharmacy.
The vaccine is proven to be safe and effective. It is required in certain occupations such as health care, where professionals might be more likely to come into contact with the virus.
The only way to prevent hepatitis C is to avoid the risk of infection. Ways to do this include avoiding the use of drugs and blood transfusions. If such interactions are necessary, extreme sterilization can be used to eliminate the risk of infection.
Sources & references used in this article:
Low-dose, titratable interferon alfa in decompensated liver disease caused by chronic infection with hepatitis B virus by R Perrillo, C Tamburro, F Regenstein, L Balart… – Gastroenterology, 1995 – Elsevier
Risk factors and outcome of 107 patients with decompensated liver disease and acute renal failure (including 26 patients with hepatorenal syndrome): the role of … by F Keller, H Heinze, F Jochimsen, JÜR Paszfall… – Renal failure, 1995 – Taylor & Francis
Immunogenicity of hepatitis A vaccine in decompensated liver disease by JA Dumot, DS Barnes, Z Younossi, SM Gordon… – The American journal of …, 1999 – Elsevier
Tenofovir disoproxil fumarate (TDF), emtricitabine/TDF, and entecavir in patients with decompensated chronic hepatitis B liver disease by YF Liaw, IS Sheen, CM Lee, US Akarca… – …, 2011 – Wiley Online Library
