Cirrhosis is a chronic liver disease that causes irreversible scarring of the liver. As cirrhosis progresses, it can lead to liver failure and other life-threatening complications. One of the most feared complications of advanced cirrhosis is the risk of sudden death.
What is cirrhosis?
Cirrhosis occurs when healthy liver tissue is replaced with scar tissue. This prevents the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver.
Cirrhosis has many possible causes. The most common causes in the United States are:
- Chronic hepatitis C infection
- Chronic hepatitis B infection
- Chronic alcohol abuse
- Nonalcoholic fatty liver disease
- Autoimmune hepatitis
- Biliary cirrhosis
- Inherited diseases
The scar tissue and other changes that occur in cirrhosis can’t be undone. However, if the underlying cause of cirrhosis is treated, further liver damage can be limited and, in some cases, reversed.
Stages of cirrhosis
Cirrhosis has different stages, from early to end-stage disease:
- Compensated cirrhosis – In early cirrhosis, the liver is extensively scarred but can still perform most of its essential functions. Many people with compensated cirrhosis have no symptoms or only mild symptoms.
- Decompensated cirrhosis – As cirrhosis progresses, more and more scar tissue forms. This blocks the flow of blood through the liver. The liver cells start to fail and the liver can’t perform its jobs well. Decompensated cirrhosis causes symptoms like fluid retention, easy bleeding and bruising, abdominal swelling, fatigue, and confusion.
- End-stage cirrhosis – Extensive scarring has destroyed most functioning liver cells. The liver can no longer perform its vital functions. End-stage liver failure is life-threatening without a liver transplant.
Complications of cirrhosis
Cirrhosis can lead to serious, even fatal, complications as it damages the liver:
- Fluid retention and swelling (ascites)
- Easy bleeding and bruising
- Sensitivity to medications
- Liver cancer
- Gallstones
- Portal hypertension
- Varices (enlarged veins that can rupture and bleed)
- Confusion and difficulty thinking (hepatic encephalopathy)
- Kidney failure
- Infection
- Liver failure
Can cirrhosis cause sudden death?
Yes, cirrhosis can sometimes lead to sudden, unexpected death. The most common causes include:
Bleeding esophageal varices
As cirrhosis causes scarring and blood flow backs up in the liver, this increased pressure causes veins around the esophagus to bulge and potentially burst. Ruptured esophageal varices can result in massive bleeding and death.
Spontaneous bacterial peritonitis
People with cirrhosis are prone to developing infections inside the abdominal cavity, called spontaneous bacterial peritonitis. This is a medical emergency and can rapidly become fatal without urgent treatment.
Hepatic encephalopathy
Advanced cirrhosis can cause toxins to build up in the bloodstream. These toxins impair brain function, resulting in confusion and coma. Sudden onset hepatic encephalopathy can be fatal.
Liver failure
End-stage cirrhosis leads to acute liver failure as the number of functioning liver cells drops critically low. The liver can no longer perform its vital functions, resulting in multiple organ failure and death.
Risk factors for sudden death
People with all stages of cirrhosis are at risk for sudden death. However, the risk is higher with more advanced disease. Factors that increase the risk of sudden death in cirrhosis patients include:
- Decompensated cirrhosis
- Presence of esophageal varices
- Prior variceal bleeding
- Portal hypertension
- Impaired liver and kidney function
- Low sodium levels
- History of infections
- Alcohol use disorder
Preventing sudden death in cirrhosis
While sudden death always remains a risk with end-stage liver disease, steps can be taken to reduce the chances of it occurring:
- Treating the underlying cause of cirrhosis – Stopping alcohol use and treating viral hepatitis, fatty liver disease, and autoimmune liver diseases can prevent further liver damage.
- Follow up care – Seeing a doctor regularly allows monitoring for signs of worsening liver function.
- Preventing infections – Vaccinations, hand washing, and avoiding sick contacts reduces the risk of infections that stress the liver.
- Treating esophageal varices – Banding or sclerotherapy can reduce the risk of variceal bleeding.
- Medications – Beta blockers lower blood pressure within the portal veins to prevent bleeding. Lactulose prevents the buildup of toxins that lead to encephalopathy.
- Nutritional therapy – Adequate calories, protein and nutrients are vital.
- Liver transplant – Transplantation is the only cure for end-stage cirrhosis.
Conclusion
Cirrhosis is a progressive disease that causes extensive scarring of the liver. Advanced cirrhosis can suddenly turn life-threatening due to severe complications like uncontrolled bleeding, sepsis, coma, and liver failure. While the risk of sudden death can never be eliminated in end-stage cirrhosis, proper treatment and preventive measures can reduce the likelihood of it occurring. Staying under the care of a hepatologist is critical for cirrhosis patients to monitor their disease and intervene before complications become fatal.