[Liver cirrhosis as a multisystem disease]

Area of Science:

• Hepatology
• Internal Medicine
• Pathophysiology

Background:

• Decompensated liver cirrhosis was previously viewed primarily through the lens of portal hypertension and hyperdynamic circulation.
• Emerging evidence highlights the critical role of bacterial translocation and subsequent systemic inflammation in decompensated liver cirrhosis.

Purpose of the Study:

• To re-evaluate the pathophysiological concept of decompensated liver cirrhosis.
• To emphasize the shift in understanding towards inflammation as a central driver of multisystemic complications.

Main Methods:

• Review of recent pathophysiological data and clinical observations.
• Analysis of the impact of systemic inflammation on extrahepatic organ systems.

Main Results:

• Systemic inflammation, driven by bacterial translocation, is a crucial factor in decompensated liver cirrhosis.
• This inflammation explains the development of various extrahepatic manifestations, including hepatorenal syndrome, cirrhotic cardiomyopathy, hepatopulmonary syndrome, hepatic encephalopathy, and adrenal insufficiency.

Conclusions:

• Liver cirrhosis is now recognized as an inflammatory-triggered multisystem disease, not solely a liver-confined condition.
• Understanding inflammation's role is vital for improving prophylaxis and treatment strategies for decompensated liver cirrhosis.