The natural history of chronic liver disease is that of a slowly progressive course, in most cases evolving over the course of years to decades. The rate of progression varies by disease state and comorbid conditions, but fibrosis advances on average by one stage every 7 to 10 years. While the development of fibrosis is reversible when the underlying etiology is successfully treated, a large number of patients present to medical attention once advanced fibrosis has already developed. The ultimate clinical and pathological manifestation of chronic liver disease is cirrhosis. Cirrhosis has long been clinically divided into “compensated” and “decompensated” disease, with an estimated 12-year survival in compensated disease and 2-year survival in decompensated disease. Additional clinical stratifications have been proposed, including a five-stage model progressing from cirrhosis without portal hypertension (hepatic venous pressure gradient below 10 mm Hg) to cirrhosis with portal hypertension, and then cirrhosis complicated by bleeding or other decompensating events. These clinical stages correspond to a step-wise increase in mortality and, with the presence of more than one decompensating event, the five-year mortality approaches 90%. The major complications of cirrhosis include varices with or without hemorrhage, ascites, hepatic encephalopathy, immune dysfunction, renal impairment, and hepatocellular carcinoma. Liver transplantation has provided an avenue to alter the course and outcomes in chronic liver disease, with graft survival rates that reach 80% at 5 years.
This review contains 4 figures, 6 tables and 51 references
Key Words: natural history, cirrhosis, mortality, hepatocellular carcinoma, acute-on-chronic liver failure
Role of antiviral therapy in the natural history of hepatitis B virus-related chronic liver disease