[Prevention of decompensation in advanced chronic liver disease].

Abstract

The transition from compensated to decompensated advanced chronic liver disease (ACLD) is associated with increased mortality. Clinically significant portal hypertension (CSPH), defined by a hepatic venous pressure gradient (HVPG) ≥10 mmHg, is the main precondition of decompensation. Non-invasive tools like transient elastography help identifying patients at risk. Preventing the first decompensation, especially ascites, is a key therapeutic goal. Non-selective beta-blockers (NSBBs), particularly carvedilol, reduce portal pressure and have shown efficacy in preventing decompensation, independent of variceal status. Lifestyle modification and treating underlying liver disease (e.g., alcohol abstinence, viral eradication) remain essential. Early identification and initiation of therapy in CSPH can change the natural history of cirrhosis and improve patient outcomes.