Stage 4 Liver Cirrhosis: Life Expectancy
If you have late-stage cirrhosis then youll need to get a MELD score. This not only helps to determine your likely life expectancy but also where you rank on the waitlist for a liver transplant. The MELD score helps to determine the chance of your life expectancy lasting 3+ months:
SCORE MORTALITY RISK
Like liver disease itself, there are 4 stages of cirrhosis.
Its important to know the various complications of liver cirrhosis. They start developing in Stage 3 and increase in number/severity during stage 4. They include:
Staging Of Liver Cirrhosis
Prognostic models and staging systems are inevitable for adequate management of patients with liver cirrhosis, especially when it comes to selecting patients for liver transplantation.19 Several classifications and prognostic models have been proposed in recent years of which the three most widely used staging systems are subsequently described briefly.
The Child-Pugh score was initially developed about 50years ago to predict the prognosis after surgery for portal hypertension in patients with liver cirrhosis.20 The original score was slightly modified later on and since then includes the following five variables: grade of encephalopathy and ascites as well as serum bilirubin, albumin and prothrombin time .21 Sometimes prothrombin index or international normalised ratio are used instead of prothrombin time.19 One to three points can be assigned for each variable and according to the sum of these points patients can be divided into three prognostic subgroups: Child-Pugh classes A , B , and C .1921 The 1-year survival rate for the stages A, B and C is approximately 95%, 80% and 44%, respectively .14
Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for liver cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the liver.
- Regional: The cancer has spread outside the liver to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body, such as the lungs or bones.
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Primary Goals In Management Ofcompensated Cirrhosis
- Treatment of the etiology of the underlying liver disease, for example:
- Antiviral treatment of HCV or HBV
- Abstinence from alcohol
Treatment For Alcoholic Liver Disease
If you do not yet have cirrhosis, your liver may heal if you stop drinking alcohol. If you are alcohol dependent, you may need professional treatment to break your addiction.
If you have cirrhosis, your doctor will talk with you about how to manage your specific complications. At this stage, some patients need a liver transplant.
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Coping With A Diagnosis
According to the VA, although cirrhosis is progressive, some people with the condition can move from decompensated, or symptomatic, back to the asymptomatic stage. This is a challenging process, although one of the critical steps is avoiding alcohol of any kind.
To prevent progressing from the asymptomatic to the symptomatic stage, people can make the following lifestyle changes:
- exercising regularly
- keeping to a moderate weight
- getting treatment for conditions that might have caused cirrhosis, such as hepatitis C or B
- getting regular check-ups and prompt treatment for complications
- quitting smoking
Of people who develop cirrhosis, 2060% also develop malnutrition, additional complications, longer hospital stays, and a reduced life expectancy.
This means eating a healthful diet is crucial for those with this condition. Cirrhosis itself can affect diet and metabolism, so people should try:
- consuming a low-salt diet
- avoiding too much vitamin A and D
- avoiding taking vitamin C, if iron levels are high
How Long Can You Live With Chronic Liver Failure And End Stage Liver Disease
Life expectancy in people with chronic liver failure and ESLD depends on various factors. For example, in an individual with alcohol-related liver disease, it depends on the severity and duration of alcohol abuse.
In general, complications of liver disease develop after 5 to 10 years, although it can even take as long as 20 to 30 years. It is impossible to predict how soon a persons health will deteriorate. Many other factors, such as other health conditions, hepatitis C virus infection, exposure to toxins, and the individuals biology, play a role.
Doctors use various methods to determine life expectancy in patients living with chronic liver failure. Two of the most popular methods are the CTP score and the Model for End-Stage Liver Disease score. A person with CTP class A has mild cirrhosis and the longest life expectancy. CTP class B is moderate cirrhosis, and CTP class C is severe cirrhosis with the shortest life expectancy.
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Advance Care Planning/social Support
While data are scarce, goals of care and advance care planning seem to be discussed less frequently with ESLD patients compared with cancer patients. In SUPPORT, 66% of ESLD patients preferred cardiopulmonary resuscitation when asked about resuscitation status.9,48 In a separate study conducted at three teaching hospitals, 16% of ESLD patients had DNR orders compared with 47% of patients with metastatic lung cancer. Housestaff were less likely to discuss these issues with ESLD patients despite awareness of their poor prognosis.49 There is an inherent difficulty in discussing advance directives with patients pursuing curative therapies and DNR orders are often considered controversial for patients awaiting transplantation. Bramstedt,50 a transplant ethicist, argues that in certain patients with ESLD, resuscitation may be futile and not in a seriously ill patient’s best interest. It is imperative to discuss goals of care and identify health care proxy agents promptly, as encephalopathy can impact decision making.
When Should I Call 911 Or Go To The Emergency Room
If you have cirrhosis and experience the following, call 911:
- Your poop are black and tarry or contain blood .
- You are vomiting blood.
- You have muscle tremors or shakiness.
- You are confused, irritable, disoriented, sleepy, forgetful or foggy.
- You have a change in your level of consciousness or alertness you pass out.
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Stage 3 Cirrhosis Of The Liver Life Expectancy
Its during the third stage of the disease that fluid accumulates in the abdomen. The clinical symptoms in this stage are very glaring. Some of them are fatigue, yellowing of the skin, weight loss, and confusion. At this stage, cirrhosis is considered to be irreversible.
When diagnosed at stage 3 the survival rate for a year is about 80%. At this stage, the doctor might recommend that a liver transplant should be done. There are chances that the body would reject the transplant. But then again if the transplant is successful the success rate is 80% for more than 5 years after the operation.
One thing though that you must bear in mind is that for cirrhosis predicting life expectancy at the late stages is quite hard. Thats because for different patients the case is unique. The life expectancy given is just an estimate calculated based on different factors. So take note that the life expectancy stated above isnt definite.
Opportunities For Collaboration Between Palliative Care And Liver Transplant Teams
Best practices for the role of palliative care in ESLD patients and transplant candidates have not been defined. The fourth edition of the Oxford Textbook of Palliative Medicine contains only three references to liver transplantation and one paragraph on palliative care in liver disease.54 The Gold Standards Framework in the UK, a guideline for care of patients with end-stage illnesses including cardiac, pulmonary, renal, and neurologic diseases, omits liver disease.55 In a survey of U.K. gastroenterologists, most had access to palliative care, but less than half referred a patient within the previous 3 months. The most common reasons for referral were end-of-life care and symptom management.56 Similarly, lung transplant clinicians favor the idea of integrating palliative care after transplantation but few make referrals.57 Palliative care interest in the liver disease population does seem to be increasing. The recently published book, Evidence-Based Practice of Palliative Medicine, contains two chapters on liver disease detailing clinical course, symptomatology and treatment considerations.58,59
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What Type Of Healthcare Providers Will Treat My Cirrhosis
Depending on the stage of your cirrhosis, different healthcare providers may be involved in your care. Healthcare professionals likely to be part of your care team include:
- Your primary care provider.
- Gastroenterologist .
- Members of a liver transplant team include: hepatologist, transplant surgeon, anesthesiologist, infectious disease specialist, nephrologist, dietitian, transplant pharmacist, physical and occupational therapist, case manager/social worker and nurses.
A note from Cleveland Clinic
Cirrhosis of the liver is a late-stage result of liver disease and its complications. Cirrhosis causes your liver to not function properly. Your liver plays a vital role in many of the processes and functions that keep you alive.
Although scarring from liver disease causes permanent damage, its still possible to live a long life. Depending on the underlying cause, its possible to slow or stop cirrhosis from worsening. Many of the causes and complications that lead to cirrhosis are treatable or manageable. If you drink alcohol, stop. If you have nonalcoholic fatty liver disease, lose weight and control your metabolic risk factors. If you have diabetes, make sure you are following your healthcare providers management recommendations. Take all medications for all your medical conditions as directed by your healthcare team. Get vaccinated for hepatitis A and B.
Last reviewed by a Cleveland Clinic medical professional on 11/01/2020.
References
What Is The Life Expectancy For Someone With Stage 4 Liver Cirrhosis
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Patient Experience Of Esld
Patients with ESLD may present in a variety of ways. Commonly, an asymptomatic phase of compensated cirrhosis progresses to portal hypertension followed by decompensation to ESLD. Complications of portal hypertension include ascites, spontaneous bacterial peritonitis, esophageal and gastric varices, hepatic encephalopathy, renal failure, and coagulopathy. Symptoms often include fatigue, abdominal bloating and pain, spontaneous bruising, gastrointestinal bleeding, and confusion.
Symptom Experience And Qol
There are few studies examining the perspective of patients living with ESLD and those undergoing liver transplantation. A Korean questionnaire-based study of 129 cirrhotic patients identified fatigue, abdominal distention, peripheral edema, and muscle cramps as the symptoms most often needing management.6 One hundred eighty-eight Australian patients with chronic hepatitis C were surveyed and 83% reported 6 or more symptoms in the past 3 months, with physical and mental fatigue, irritability, depression, and abdominal pain being the most frequently reported.7 The SUPPORT Study reported that 60% of ESLD patients identified experienced pain.8 This was rated at least moderately severe most of the time in 1 of 3 patients.9 There is often a discrepancy between patient-reported symptom burden and physician awareness of such symptoms, for example, muscle cramps, which occurred in 52% of 92 cirrhotic patients in a 1996 survey, are not often identified as an issue by physicians.10
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Whats The Life Expectancy For People With Cirrhosis
Life expectancy depends on several factors including the cause and severity of your cirrhosis, your response to treatments, presence of cirrhosis complications, your age and any other existing general health problems. Ask your liver specialist about your life expectancy since every person is unique, with unique overall health issues and specific liver health issues.
If your cirrhosis is advanced, liver transplantation may be an option. You and your doctors will discuss if this is an option for you.
Stage 4 Liver Cancer Symptoms
The initial stages of liver cancer may not show any signs of the disease. After stage 3 liver cancer, as the disease extends its stay in the body, the signs and symptoms are more prominent and arent always directly related to the diagnosed cancer stage. The effects of cancer on a person is subjective, but some of the symptoms include
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Risk Factors For Cirrhosis
- Alcoholic liver disease and hepatitis C are the most common causes in developed countries.
- Hepatitis B is the most common cause in parts of Asia and in sub-Saharan Africa.
- There may also be a genetic predisposition to cirrhosis which may explain the variable rates of its development in people with similar risk factors .
- Continued alcohol consumption increases the rate of progression of cirrhosis from any cause.
- Risk factors for the development of cirrhosis in those with chronic hepatitis C infection:
- Regular alcohol consumption.
What Are The 4 Stages Of Liver Disease
posted: Jul. 22, 2021.
How your gastroenterologists in Huntsville, AL, can diagnose and treat liver disease
Your liver is an important organ that works to eliminate toxins from your body. When you have liver problems, toxins can build up in your body, causing damage to your organs and tissues. Fortunately, your gastroenterologist is an expert at diagnosing and treating liver disease.
Dr. E. Anthony Ugheoke at Associates In Gastroenterology in Huntsville, AL, offers comprehensive GI services, including diagnosis and treatment of liver disease.
Liver disease can be caused by a virus, excessive alcohol use, obesity, poor diet, genetics, an autoimmune disease, or a drug reaction.
There are 4 stages of liver disease:
Early diagnosis of liver disease is the key to early treatment, which can mean a better outcome for you. Liver disease in the early stages is treatable because your liver has a great ability to heal itself. As liver disease progresses, the livers natural healing abilities decrease.
To learn more about the causes, diagnosis, and treatment of liver disease, call Dr. E. Anthony Ugheoke at Associates In Gastroenterology in Huntsville, AL. You can reach him at 883-0098, so call today!
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Upstream Integration Of Palliative Care Into Hepatology And Transplant Care
Introduction of palliative care for patients with ESLD and those awaiting transplant can be challenging. Many patients feel well for years after diagnosis and develop symptoms of ESLD abruptly. This allows less time to acquire coping skills needed to face progressive illness and approach the end of life. End-of-life discussions can be difficult as patients often focus their hope on obtaining a life-saving transplant.60 Many surgical specialists, like other clinicians, may think of palliative care as synonymous with end-of-life care. In 2005, the American College of Surgeons released a statement extending the palliative care needs of surgical patients to include those at all stages of disease.61 There has been increased support in the transplant community for integration of palliative care as evidenced by this statement in Surgical Clinics of North America:âThe fields of transplantation and palliative care have a treasure trove of experience that is lacking in the other that could be exchanged profitably with a great sense of satisfaction for all.â62 Such a statement suggests an opening in the transplant community to start a dialogue with palliative care specialists.
What Are The Symptoms Of Cirrhosis
The symptoms of cirrhosis depend on the stage of your disease. In the beginning stages, you may not have any symptoms. If you do have symptoms, some are general and could easily be mistaken for symptoms of many other diseases and illnesses.
Early symptoms and signs of cirrhosis include:
- Loss of appetite.
- Redness in the palms of your hands.
- Spider-like blood vessels that surround small, red spots on your skin .
- In men: loss of sex drive, enlarged breasts , shrunken testicles.
- In women: premature menopause .
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How Is Cirrhosis Of The Liver Diagnosed
Your healthcare provider will first ask about your medical history and over-the-counter and prescription drug use. They will also ask about any supplements or herbal products you may take. Your provider may suspect you have cirrhosis if you have a long history of alcohol abuse, injectable drug abuse or have had hepatitis B or C and have the symptoms listed in this article.
To diagnosis cirrhosis, your provider will perform a physical exam and may order one or more of the following tests:
- Physical exam: Your doctor will examine you, looking for the signs and symptoms of cirrhosis including: the red, spider-like blood vessels on your skin yellowing of your skin or whites of your eyes bruises on your skin redness on your palms swelling, tenderness or pain in your abdomen enlarged firmer-feeling, bumpy texture to the lower edge of your liver .
- Blood tests: If your doctor suspects cirrhosis, your blood will be checked for signs of liver disease. Signs of liver damage include:
- Lower than normal levels of albumin and blood clotting factors .
- Raised levels of liver enzymes .
- Higher level of iron .
- Presence of autoantibodies .
- Raised bilirubin level .
- High white blood cell count .
- High creatinine level .
- Lower levels of sodium .
- Raised level of alpha-fetoprotein .
In addition, other blood work will include a complete blood count to look for signs of infection and anemia caused by internal bleeding and a viral hepatitis test to check for hepatitis B or C.
