Liver Cirrhosis Survival timeline & How to calculate it.

The liver cirrhosis survival timeline depends on the severity of cirrhosis. For example, people with early-stage cirrhosis have an 85% survival rate after two years, while patients with late-stage (CTP score C) have a 35% 2-year survival rate.

Some landmark statistics to help you understand the survival timeline with liver cirrhosis:

• People with early compensated cirrhosis (no signs or complications of cirrhosis) have a survival time > 12 years (reference).
• Patients with advanced cirrhosis (child C) have the worst survival time. Only 38% will survive for two years.
• Up to 20% of patients with bleeding varices die within the first 30 days of the attack.

Keep reading this article for more insightful facts and statistics about liver cirrhosis survival timelines.

What is cirrhosis, and why does it affect survival?

Your liver is one of the vitally important organs in the body. It carries out many essential functions for your body’s health and survival.

For example:

• It receives, processes, and stores major nutrients needed by your body.
• It breaks down, detoxifies, and eliminates toxins, drugs, and dangerous chemical waste.
• It manufactures essential substances such as coagulation factors, albumin, and other nutrients.
• It supports your immune system and plays a significant role in fighting infections.
• It acts as an energy storage system.

Most significant chronic liver diseases end in liver cirrhosis. The term (cirrhosis) refers to intense fibrosis and scarring of the liver tissues.

The profound destruction of the liver tissue results in the gradual decline of its function, which may often lead to serious complications.

Patients with early compensated cirrhosis often have a good survival time. However, late-stage liver cirrhosis decreases the survival time significantly due to the decline in liver function.

Failure of the liver to perform its function leads to profound arrangements in many body functions, such as:

• Low albumin and malnutrition.
• Accumulation of fluids inside the body (due to low albumin and the inability of the liver to receive blood from the gut (portal hypertension).
• The inability of the body to deal with toxins and waste products.
• The affection of the conscious level (hepatic encephalopathy).
• Dilation of the blood vessels in the walls of the esophagus and stomach that eventually bleeds (variceal bleeding).
• Increased risk of infections (which may become life-threatening due to a weak immune system).
• Increased risk of cancers such as hepatocellular carcinoma.
• The cirrhotic liver becomes vulnerable to stressors such as infection, bleeding, etc. In addition, the liver may acutely fail due to minor events (acute on top of chronic liver failure).

The above consequences and complications significantly shorten the survival time in patients with advanced liver cirrhosis.

How do we determine the severity of cirrhosis (which relates to survival)?

As we explained before, the survival timeline prediction depends on determining the severity of liver cirrhosis.

Several scoring systems exist to categorize the severity of cirrhosis. The two most famous scores are the Child-Turcotte-Pugh (CTP) score and the Model for end-stage liver disease (MELD) scores (reference).

For simplification, we will explain one of them and its relation to survival: the Child-Pugh score.

The Child-Pugh score assign points to five laboratory and clinical parameters that determine the severity of liver cirrhosis.

These five parameters include:

• Ascites severity.
• Bilirubin levels.
• INR (international normalized ratio) levels.
• Albumin levels.
• Hepatic encephalopathy

How to calculate liver cirrhosis survival time by yourself:

What you will need:

• A recent abdominal ultrasound report containing the degree of ascites.
• A recent laboratory test result for  bilirubin
• INR,
• and albumin level
• Knowledge of the previous history of hepatic coma (hepatic encephalopathy) and its severity.

Regarding hepatic encephalopathy, it is either:

• Absent.
• Mild (grade 1 or 2): in the form of mild cognitive affection, confusion, or mood changes.
• Severe (grade 3 or 4) in the form of agitation, deep confusion, or coma.

Then, using a calculator, you can assess the exact CTP score.

The table below summarizes the Child-Pugh score (reference)

The link below is a simplified calculator to calculate the Child-Pugh score easily.

https://www.hepatitisc.uw.Edu/page/clinical-calculators/ctp

The score calculated predicts liver cirrhosis’s survival time according to the table below (reference):

The chart below is a graphic representation of the predicted survival timeline for different child classes:

• Child class A (green line): has the best survival.
• Child Class B (yellow line): has an intermediate survival time.
• Child class C (red line): has the worst survival. Only 38% of patients with Child class C survive for two years.

The most common cause of death from liver cirrhosis.

The more advanced liver cirrhosis, the more likely the complications to occur. Patients with end-stage liver cirrhosis are at higher risk of complications and death.

The table below summarizes liver cirrhosis’s most common causes of death (reference).

Learn more about the causes and symptoms of End-stage liver cirrhosis before death.

How do you know when your liver is shutting down?

The following are signs and symptoms of a liver shutdown (acute on top of chronic liver failure):

• Worsening of jaundice or new onset of jaundice.
• Very dark urine.
• Diffuse skin bruising and easy bleeding.
• Worsening ascites (non-response or inadequate response to diuretics).
• Worsening lower limb edema.
• Passge of black stools (melena).
• Vomiting of blood.
• Recurrent or severe alteration of the consciousness (hepatic encephalopathy).
• Severe wasting of the limb and facial muscles (cachexia).
• Laboratory signs include very low albumin, very high bilirubin, and INR.
• Imaging signs include the presence of hepatocellular cancer, portal vein thrombosis, massive ascites, etc.

The above signs, lab, and imaging findings are considered predictors of poor survival in patients with liver cirrhosis.

Tips to improve survival with liver cirrhosis:

• To prevent further damage, hepatitis B or C patients should receive anti-viral treatments (when indicated).
• Stop alcohol consumption (whether the cirrhosis is due to alcohol or not).
• Medications such as beta-blockers, laxatives, and diuretics help to prevent complications and improve survival.
• Close monitoring and screening for complications such as HCC or kidney impairment.
• Avoid a high-protein, high-salt, and high-fat diet.
• Avoid unwanted medications (Too many medications can cause determination of the liver function in cirrhotic patients).
• Liver transplantation (when indicated) is one of the best treatments that improve survival (successful transplantation provides a cure for cirrhosis).