How to know what stage of cirrhosis you are in

[princess_shar]

My common law was diagnosed with Hep C in 2001 and told to stop drinking.  He slowed down, but is now back up to between 6 and 12 beers a day and sometime jagermeister, a bottle at a time.  He has signs of cirrhosis but will not go to doctor because he doesn't want to get cut off drinking and smoking.  I just want to know if he has cirrhosis what stage he is in, and approx. how much longer he has to live.  He is refusing to quit and is preparing to die.
His signs are edema, blood in vomit, and stools and nose bleeds everyday.  He is sore in the abdomen, and his left shoulder is in constant, severe pain.  He has mood swings all the time, and his sleeping pattern changes every day.  He is lucky to eat once a day, sometime once a week.  He has constant diarrhea.  He bruises if you touch him in any way.  He has lost almost all of his muscles.  He is having problems breathing, coughs a lot, and has heart palpitations.
He had a heart attack more than 10 years ago and was told not to do anything strenuous.  So he sits in his chair all day drinking and smoking.  He smokes 2 packs a day.
I want to be prepared myself for when the time comes.  I need to be prepared, but don't know how much time I have.  I am at wits end with his moods.  He is verbally abusive right now, and I just keep holding on so I know he isn't alone.

[HectorSF]

I wish you the best in getting together with your sister. It sounds to me that you are doing all that you can to make it happen for all of you including your mom. That is all any of us can do. Try to do the right thing. The outcome is beyond our control.

Keep up the good work.
Happy Holidays to you. :-)
Hector

[fanofhawks]

Thank you for breaking this down for me.  I am in the dark about her and have been for 5 yrs.  because I don't know the specifics.  She is supposed to come up for a visit in the Spring, and she is giving us excuses.  I only have to assume that she is not well.  I don't know what else to think.  We have always gotten along well up until the near-death experience she had 5 yrs. ago and then she became very secretive.  It's just difficult to know why she doesn't want to see us.  My mother is almost 90 yrs. old and wants to see her so badly.   I appreciate your time and response.  It is very informative.  

[HectorSF]

Hi thanks for writing.

Many laymen use the tern End-Stage Liver Disease (ESLD) very loosely when taking about cirrhosis. Using it for anyone diagnosed with cirrhosis. Medically speaking there are 3 "stages" or "classes" of cirrhosis as stated above. People with true ESLD are just that. End stage. Meaning they are at the end of life. Their liver disease is irreparable and their liver is progressively failing. These are people with high MELD scores (the MELD score ranges from 6 - 40, 40 being the sickest people need a liver transplant soon because there liver function is irreversibly failing. These are the people that are on transplant waiting lists that need transplants to continue to stay alive.

Those with lesser classes of cirrhosis can live many years with their cirrhosis. Many people with compensated cirrhosis (class A cirrhosis) may have no symptoms and feel perfectly fine. Even their blood levels may be within normal ranges. It doesn't mean they are sick but their liver is still able to perform all of its functions so they have no complications from their cirrhosis.

Those with true ESLD have MELD scores typically in the upper 20s to 40 have many life-threatening complications and are frequently hospitalized. HE comas, internal bleeding causing them to vomit or defecate of blood. Jaundice or life-threatening infections are common in these patients.A person with a MELD score between 30-39 has only about a 40% of being alive in 6 months. This is what we see every day at my liver transplant center where we care for those with ESLD. Happily many of these people and myself have been saved by getting a liver transplant.

So the reality of cirrhosis can vary tremendously medically, symptom and complications wise.

Is she still considered ESLD?
Only a doctor knowing her current health info can know.  

Or is she considered in a different stage of cirrohsis after 5 yrs.?
People who who truly have End-Stage Liver Disease don't live for 5 years without a transplant.

"She was not on a diuretic when she was discharged from the hospital 5 yrs. ago, and she was only on a low-salt diet.  Now, she is on a diuretic and a no-salt diet and she has had some kidney problems."

A low salt diet is the first step in controlling fluid retention issues (called ascites and peripheral edema). a very common complication of decompensated cirrhosis. Diuretics are added when a low salt diet alone is not able to control the fluid build-up.

I should mention the alcoholic liver disease (ALD) and its complications can often be reversible in the early stages of cirrhosis, if a person stops drinking. Which is why abstinence is critical for the management of alcoholic liver disease. So a person having many complications while drinking can often see a large improvement in their cirrhosis and complications if they stop drinking.
Most other conditions or diseases that cause liver disease (autoimmune disease, some hereditary liver diseases) often can't be stopped or controlled and there is continual ongoing injury to the liver and a progressive advancement of their liver disease.
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The Child-Pugh score is a scoring system to measure the severity of cirrhosis. The intention is to provide a system with 3 classes or stages of disease with which clinicians can objectively communicate about liver function.
Note: The MELD score is now more commonly used in the clinical setting as it is the MELD score number that is used to determine who is in the most need for liver transplantation.

The Child-Pugh score is composed from several categories:

* total bilirubin, μmol/l (mg/dl)
        50: 3 points

* serum albumin, g/l
        >35: 1 point
        28-35: 2 points
        <28: 3 points

* INR
        2.3: 3 points

* presence of Ascites
        none: 1 point
        mild: 2 points
        moderate to severe: 3 points

* presence of Hepatic Encephalopathy (HE)
        none: 1 point
        grades I-II (or suppressed with medication): 2 point
        grades III-IV (or refractory): 3 point

The point scores are then added up and classified as:

    class A (Compensated cirrhosis): 5-6 points
    class B Decompensated cirrhosis) : 7-9 points
    class C (End-Stage Liver Disease): 10-15 points

I hope this answers your questions about the range of liver disease in people with cirrhosis.
Hector

[fanofhawks]

In regards to your answer to the princess above, I am confused about the 3 general stages of Cirrhosis.  My sister almost died 5 yrs ago and was diagnosed with ESLD.  She took responsibility for her drinking ways, and stopped drinking and put herself on the diet recommended by her doctor.  She is still managing her cirrohosis with a diuretic, a no-salt diet, and hopefully she is still alcohol free.  (I don't really know because we havent' seen her in over 3 yrs. and she doesn't tell us how she is).  

My question to you is this:  Is she still considered ESLD?  Or is she considered in a different stage of cirrohsis after 5 yrs.?  She was not on a diuretic when she was discharged from the hospital 5 yrs. ago, and she was only on a low-salt diet.  Now, she is on a diuretic and a no-salt diet and she has had some kidney problems.  She could be on other medications, but I don't know this.  So is this still ESLD or is this another stage of cirrohsis?  

[HectorSF]

I am very sorry to hear that you are dealing with such a difficult situation and it is putting you in a very tough position. Trying to do the right thing for someone who can’t see what is for his own good.

As far as How long someone can live with their cirrhosis?…no one can predict exactly how long someone with cirrhosis will live. The disease progresses differently in each person depending on many factors. One of course being his drinking on top of hepatitis C infection which continues to add further injury to their liver.

So first in order to properly assess how advanced someone’s cirrhosis is requires a full medical evaluation by a qualified doctor. A gastroenterologist or hepatologist. A number of medical tests would need to be done including a complete medical history including a history of alcohol or drug use, his hepatitis C history, a physical exam, various blood tests and scans. Only then can a realistic prognosis of his liver disease be arrived at.

Cirrhosis is divided into 3 general stages or classes. Going from the lesser to the more advance stages of disease.

* Compensated cirrhosis, this means that the body still functions fairly well despite scarring of the liver. Many people with compensated cirrhosis experience few or no symptoms.

* Decompensated cirrhosis, at this stage of the disease the severe scarring of the liver has damaged and disrupted essential body functions. Patients with decompensated cirrhosis develop many serious and life-threatening symptoms and complications such as ascites, varices that may bleed, hepatic encephalopathy, etc.

* Finally End-Stage Liver Disease (ESLD) – the final stage when the only option to continue living is a liver transplant.

Sadly if he continues to drink and not take responsibility for his health and life there is very little that can be done for any adult who doesn’t want help.

In the end…only he can choose to live or continue his ways and suffer the inevitable outcome. No one can do it for him.

Let’s hope he will realize he is on the wrong road before it is too late.

Best wishes to you.
Hector