Compensated Cirrhosis Of Hepatitis B: Understanding The Decompensation Stage

Decompensated cirrhosis of hepatitis B refers to the stage where liver function begins to fail in patients who already have hepatitis B-related cirrhosis. This condition typically arises in individuals with a confirmed hepatitis B infection, as indicated by positive results for the hepatitis B surface antigen (HBsAg), e-antigen (HBeAg), e-antibody (HBeAb), or core antibody (HBcAb). Some patients may also test positive for HBV-DNA, which indicates active viral replication.

In terms of diagnosis, imaging techniques such as color Doppler ultrasound or computed tomography (CT) scans often reveal signs of liver hardening or portal hypertension. Additionally, endoscopic exams might show esophageal or gastric varices, while blood tests frequently indicate a reduced platelet count (<100×10^9/L), which is commonly associated with advanced liver disease.

The decompensation phase is marked by severe complications. These include recurrent ascites (fluid accumulation in the abdomen), persistent jaundice (yellowing of the skin and eyes), hepatic encephalopathy (a decline in brain function due to liver failure), and potentially life-threatening gastrointestinal bleeding caused by ruptured varices.

This stage of the disease is considered to be late or end-stage cirrhosis, with a five-year survival rate ranging between 14% and 35%. Given the severity of this condition, comprehensive treatment strategies are essential. These should target both the underlying hepatitis B virus and the symptoms of liver dysfunction.

Effective management includes antiviral therapy, symptom control, and regular monitoring. Antiviral medications can help suppress the virus and slow disease progression, while managing complications like ascites, encephalopathy, and variceal bleeding is crucial for improving quality of life and survival rates. Patients at this stage may also need to be evaluated for liver transplantation, which remains the most definitive treatment option for eligible candidates.