Decompensated liver cirrhosis

The incidence of liver disease continues to increase and is now one of the leading causes of death in the United Kingdom. The increasing prevalence of viral hepatitis combined with a surge in the incidence of both alcohol and obesity related liver disease mean that critical care units are increasingly being called upon to assist in managing those with life-threatening complications or end-stage liver disease. Decompensated cirrhosis is not a single organ illness but a complex multi-system disorder typified by impaired immunity, malnutrition and multi-organ failure and presents a significant challenge to the critical care physician. In this article we describe the epidemiology, aetiology and pathophysiology of decompensated liver disease and describe the management strategies of a range of resulting clinical complications.