Background: Liver cirrhosis, the end-stage of chronic liver disease, is a major cause of global morbidity and mortality. Its clinical course is characterized by the development of life-threatening complications, including portal hypertension, ascites, hepatic encephalopathy (HE), hepatorenal syndrome-acute kidney injury (HRS-AKI), and hepatocellular carcinoma (HCC). The management of these conditions is complex and has evolved significantly in recent years.

Objective: This review aims to synthesize recent evidence and provide a comprehensive overview of the contemporary, evidence-based strategies for the diagnosis and management of the major complications of decompensated liver cirrhosis.

Methods: A narrative review of the literature was conducted using prominent databases. The synthesis focuses on seminal studies, clinical guidelines, and recent trials that have shaped the current understanding and treatment paradigms for cirrhosis complications, drawing from a curated list of 34 key references.

Findings: Management of portal hypertension and varices has been refined with non-invasive diagnostics and clear prophylactic strategies. For ascites, the focus remains on diuretic management and timely intervention for refractory cases, while new insights into bacterascites and spontaneous bacterial peritonitis (SBP) have improved infection control. The treatment of HE is centered on ammonia-lowering agents like lactulose and rifaximin. The diagnostic criteria for HRS-AKI have been updated for earlier recognition, with vasoconstrictors (e.g., terlipressin) and albumin forming the cornerstone of medical therapy. For HCC, enhanced risk stratification models and regular surveillance in cirrhotic patients are critical for early detection and access to potentially curative therapies.

Conclusion: The management of cirrhosis complications has advanced significantly, moving towards earlier diagnosis and targeted, evidence-based interventions. A multi-faceted approach addressing each complication is crucial for improving patient outcomes. Future research should focus on novel therapies targeting the underlying pathophysiology of portal hypertension and fibrosis to prevent decompensation and improve survival.

Liver Cirrhosis, Decompensated Cirrhosis, Portal Hypertension

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