Cirrhosis is a serious disorder of the liver and is often associated with a number of life-threatening complications such as coughing up blood, kidney failure, build up of fluid in the abdomen, infections, easy bleeding, and mental status changes. The progression of cirrhosis depends on many factors and it is impossible to state with certainty what the life expectancy will be for every person.
In most patients with cirrhosis, the general course is characterized by a gradual worsening of overall health. Most patients eventually develop fluid in the abdomen (ascites). Once patients develop complications, life expectancy is severely reduced. For those who remain complication-free, the life expectancy can be prolonged but nowhere to what a normal healthy adult would live.
In general, other than stating that patients with cirrhosis have a shortened life expectancy, the course of the disorder is extremely variable from patient to patient. The reasons for this variability are because the cirrhosis may be different in different people (some causes are amenable to treatment and others are not), degree of liver reserve, availability of means to prevent the worsening of liver damage, and most important, development of liver cancer. Other factors that must be taken into account when predicting life expectancy include the ability of the patient to undergo a given therapeutic intervention or whether there is any therapeutic option that can improve liver function.
How to Predict Life Expectancy with Cirrhosis
Life expectancy with a person suffering from cirrhosis of the liver is hard to predict as the condition depends on a range of factors that in combination can compromise the prognostic value. Several tools have been developed that enable physicians to be able to predict the severity of liver cirrhosis and life expectancy.
In accordance with the Child-Pugh score, there are three major types of cirrhosis – A, B, and C that are generally used in medicine for the cirrhosis prognosis assessment. Five clinical measures of liver ailment are employed in the score, where each of them is scored from 1 to 3.
The score a person gets determines the type of cirrhosis – class A, class B, or class C.
- Class A cirrhosis – 5-6 points – a live expectancy of 15-20 years.
- Class B cirrhosis – 7-9 points – a life expectancy of 6-10 years.
- Class C cirrhosis – 10-15 points – a life expectancy of only 1-3 years.
The score used to be a measure for the strength of treatment required as well as the necessity of liver transplantation and now it is a life expectancy assessment tool. At the present moment, there are also other scores that can help in providing a much clearer prognosis and they are also as broadly employed as the Child-Pugh Score: the MELD score and MELD-Na.
These tools are not set in stone but just provide a rough estimate of how long a patient may survive. Most tools use a scoring system that assesses the severity of complications, the age of the patient, liver function, nutritional status, bleeding parameters, and other associated comorbidities like diabetes, intake of alcohol, and lung and kidney disease. In general, the higher the score on any one of these tools means a shortened life expectancy.
Over the last two decades, the availability of liver transplantation has helped improve survival and life expectancy in people with liver cirrhosis. However, the problem with liver transplantation is that there simply are not an adequate number of organs to go around and this remains a major stumbling block. It is also important to understand that just because one undergoes a liver transplant does not automatically mean he or she will live longer. A liver transplant is an extremely complex procedure with numerous life-threatening complications. Further and more important, patients with liver cirrhosis are frail and not always in the best shape to undergo a major surgical procedure. The procedure does carry a risk of death and the patient always has to be on potent medications to suppress the immune system; this also results in many side effects and the development of opportunistic infections.
There have also been advances made in the treatment of hepatitis B with antiviral drugs. These drugs have been shown to decrease the progression of liver damage and improve the quality of life. Unfortunately, there are no effective medications for the management of hepatitis C.
Patients with liver cirrhosis who remain complication-free can expect to live longer than those who do not. Once a patient develops complications and needs admission to a hospital, survival is markedly reduced. If the patient needs ICU admission, then the risk of death is markedly increased chiefly because of multiorgan failure. Some of these patients may be saved if there is a liver transplant available.
A Rough Guide to Life Expectancy
- Patients with low scores and without complications may live for 12-20 years after the diagnosis is made provided that they do not consume alcohol and take precautions to protect the liver.
- Patients with high scores who develop complications may survive anywhere from 3 months to 3 years.
- For those who have a successful liver transplant, at least 80% can expect to live for at least 5 years. Unfortunately, even when a liver donor is available, many patients are simply not physically fit to undergo the procedure.
Ways to Improve Life Expectancy
Some of the ways to improve your life expectancy after a diagnosis of liver cirrhosis are to:
- not take medications (both prescription and over the counter) that can damage the liver
- avoid alcohol
- eat low sodium but a well-balanced diet
- get vaccinated against the flu and hepatitis A and B and
- wash hands frequently to reduce the risk of infections.
Liver Cirrhosis – The National Center for Biotechnology Information (NCBI)
Cirrhosis – NHS Choices
American Liver Foundation materials
Beyond “Cirrhosis”: A Proposal From the International Liver Pathology Study Group – American Journal of Clinical Pathology, Volume 137, Issue 1, 1 January 2012, Pages 5–9, Published: 01 August 2015
Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies – The National Center for Biotechnology Information (NCBI)