7 Causes of Sudden Death from Liver Cirrhosis.

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The liver on one of the vital organs in the human body. You may become at higher risk of sudden death when the liver fails (as with cirrhosis).

However, cirrhosis is a very slow process. It may take years or even decades for liver disease to cause cirrhosis.

Also, cirrhosis itself is slowly progressive. The early stages of liver cirrhosis don’t often cause major health issues.

MORE: Liver Cirrhosis Survival timeline & How to calculate it.

Today, you will learn about the causes of sudden death associated with liver cirrhosis. The article will include both the hepatic and non-hepatic causes of sudden death in patients with cirrhosis.

1. Massive bleeding from varices.

Patients with advanced liver cirrhosis develop dilated veins in the walls of the esophagus and the stomach (called the esophageal and gastric varices, respectively).

Eventually, these dilated veins suddenly rupture, and massive bleeding occurs.

The bleeding can be:

  • Vomiting of blood (hematemesis). 
  • Passage of dark (black or tarry) stools (melena). 
  • Both hematemsis and melena. 

Many people die after hematemesis or melena’s first attack due to end-stage liver disease. One study estimated that 24% of patients die within six weeks of the first attack of hematemesis and melena.

Patients with massive attacks are at very high risk of sudden death from this liver cirrhosis complications.

Patients may suffer from non-specific symptoms before the onset of hematemesis and melena, such as:

  • Shortness of breath. 
  • Nausea. 
  • Fullness in the upper stomach area. 
  • Abdominal pain. 
  • Dizziness, lightheadedness. 
  • Fainting.
  • Pallor. 
  • Patients with advanced cirrhosis may develop coma (liver cirrhosis due to bleeding). 

The condition becomes obvious when melena or hematemesis occurs. If the condition needs emergency medical assistance, go to the ER immediately or call 911. 

The treatment consists of:

  • Resuscitation with fluid and blood. 
  • Medications that decrease the pressure inside the varices (such as terlipressin) prevent bleeding. 
  • Plasma
  • Emergency endoscopy to spot the bleeding varices and treat it. 

2. Cardiac death in patients with liver cirrhosis.

Patients with liver cirrhosis are at higher risk of major heart diseases such as heart attacks (myocardial infarction) and arrhythmias (abnormal rate or irregularity of the heartbeats).

Studies show that the rate of sudden death from heart-related conditions is higher among cirrhotic patients than in non-cirrhotic people.

The two major heat diseases that cause sudden death are:

  • Myocardial infarction.
  • Heart arrhythmias.

A. Myocardial infraction.

Contrary to popular belief, patients with liver cirrhosis are at higher risk of thrombotic events (obstruction of their blood vessels).

One study found that patients with liver cirrhosis have a higher risk of coronary artery disease (heart attacks). In this study, the prevalence of coronary artery disease was:

  • 12% in the non-cirrhotics.
  • 20% in patients with liver cirrhosis.

Symptoms and diagnosis:

  • Sudden onset severe compressing chest pain.
  • The pain may radiate to the jaw, left shoulder, left arm, or the upper stomach area.
  • Sudden shortness of breath.
  • Sweating.
  • Nausea and/or vomiting.
  • Sudden dizziness, fainting, or coma.
  • Myocardial infarction is one of the most common causes of sudden unexpected death in patients with liver cirrhosis.
  • The diagnosis of the condition is often by an Electrocardiogram (ECG) and/or a lab test (troponin).

B. Heart arrhythmias.

Arrhythmia is a term that refers to derangements in the rate or rhythm of the heartbeats.

Patients with liver cirrhosis are at higher risk of arrhythmias because of multiple medications (such as diuretics) and electrolyte disturbances (such as low sodium and calcium levels).

Moreover, patients with liver cirrhosis have multiple metabolic arrangements, renal affections, and impaired drug and toxin excretion (reference).

Arrhythmias means one or more of:

  • The heart beats too rapidly.
  • The heart beats too slowly.
  • The heart beats in an irregular rhythm.

Not all arrhythmias are dangerous. Some arrhythmias are benign, and others are life-threatening.

Examples of life-threatening arrhythmias that may cause sudden death in patients with liver cirrhosis include:

  • Ventricular fibrillation (VF).
  • Ventricular tachycardia.
  • Paroxysmal supraventricular tachycardia.
  • High-grade Atroioventricular blook.

Cirrhotic patients who die suddenly from arrhythmia often have sudden onset palpitations (awareness of heartbeats), chest pain, and/or fainting.

An ECG diagnoses the condition. Call your doctor immediately if you have sudden palpitation without obvious cause.

3. Acute liver failure on top of cirrhosis.

Patients with liver cirrhosis are at higher risk of sudden deterioration of their liver functions due to stressors such as:

  • Infection. 
  • Variceal bleeding. 
  • Dehydration and/or hypotension. 
  • Operations (surgery). 
  • Hepatotoxic drugs. 
  • Advanced liver cancer. 
  • And others. 

The above factors may cause the acute failure of the cirrhotic liver and cause sudden death. 

One study found that 24% of the deaths in patients with liver cirrhosis are due to acute liver failure on top of cirrhosis. 


  • New-onset or worsening of existing jaundice. 
  • Confusion or loss of consciousness (hepatic encephalopathy). 
  • Worsening of ascites and edema. 
  • Fever if there is an infection. 
  • Deterioration of the kidney functions (little or no urine, elevated kidney function test, etc.).
  • Diffuse skin bruising. 
  • Severe wasting of the muscles. 

4. Brain stroke. 

Patients with liver cirrhosis have a higher risk of brain stroke (particularly cerebral hemorrhage) (reference).

Brain strokes are one of the common causes of SUDDEN unexplained death in cirrhotic patients.

The risk of brain stroke in cirrhotic patients is TWICE the risk of stroke in the non-cirrhotics (reference):

  • The incidence of stroke in non-cirrhotics: 1.11% per year.
  • The incidence of stroke in cirrhotic patients: 2.17% per year.


  • Sudden confusion or coma (unlike hepatic encephalopathy, the loss of consciousness is sudden, NOT gradual). 
  • Sudden numbness or weakness at one side of the body (one arm, one leg, or both) or one side of the face. 
  • Sudden trouble seeing or speaking. 
  • Sudden severe headache or dizziness. 

5. Infection. 

Patients with advanced liver cirrhosis have a weak and slow immune system. Therefore, infections

in patients with liver cirrhosis can cause severe and sudden deterioration or even death within a few days.

The death occurs due to either:

  • Increase severity or spread of the infection due to a weak immune system (septicemia). 
  • Deterioration of liver condition (acute on top o chronic liver failure). 

Common infections include:

  • Infection of the ascites (spontaneous bacterial peritonitis). 
  • Urinary tract infection. 
  • Chest infection. 

6. Other causes of sudden death in patients with liver cirrhosis:

  • Kidney failure (hepatorenal syndrome). 
  • Lung failure (hepato-pulmonary syndrome). 
  • Pulmonary embolism.
  • Ruptured hepatic focal lesions. 

BONUS: who are at higher risk of sudden death from liver cirrhosis.

Generally, patients with advanced liver cirrhosis are at higher risk of sudden death.

Sudden death is more likely to occur in cirrhotic patients with:

  • Recurrent or newly developed bleeding esophageal varices.
  • Patients with risk factors for heart disease such as smoking, diabetes, previous history of heart attacks.
  • Recurrent hepatic encephalopathy. 
  • Progressive jaundice. 
  • Kidney impairment.
  • Profound lab arrangement (progressive elevations in bilirubin, prothrombin time, and low albumin). 
  • Progressive muscle wasting and cachexia. 
  • Presence of liver cancer (hepatocellular carcinoma).