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Hospital Healthcare Europe
Hospital Healthcare Europe

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

Angeli P et al
4 December, 2019  

The European Association for the Study of the Liver released updated guidelines for the management of decompensated cirrhosis and its complications.

A panel of hepatologists reviewed the currently available literature on management of frequent complications such as ascites (uncomplicated and refractory), hepatic hydrothorax, hyponatraemia, gastrointestinal bleeding, bacterial infections, acute kidney injury, hepatorenal syndrome, liver and adrenal failure, hepatopulmonary syndrome, portopulmonary hypertension, and cirrhotic cardiomyopathy, some of which were not addressed in the previously published guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis.

The article reviews the pathophysiology and diagnosis of decompensated cirrhosis and emphasises the importance of early treatment with antibiotics and beta-blockers to prevent disease progression and improve clinical outcomes.

Moderate restriction of sodium intake is recommended in cases of moderately severe ascites without complications, but treatment of recurrent ascites requires anti-mineralocorticoid agents and furosemide.

The role of albumin in improving circulatory and kidney function, relieving muscle cramps, and plasma volume expansion in patients undergoing large-volume paracentesis for refractory ascites is reviewed.

Its use is also recommended for spontaneous bacterial peritonitis and acute kidney injury-hepatorenal syndrome. Evidence supporting potential uses of albumin in hypervolaemic hyponatraemia is also discussed.