Epidemiology and Natural History of Chronic Liver Disease

Chronic liver diseases are prevalent around the world and their incidence and prevalence are increasing. Cirrhosis which is the end result of any chronic liver disease carries an increased risk of morbidity and mortality and is currently the 12th leading cause of death in the United States. The prognosis of patients with cirrhosis is dependent on the presence or absence of decompensating events (ascites, encephalopathy, and variceal bleeding). The rate of development of these events is variable across different disease entities and patient populations and is associated with increased morbidity, mortality, and healthcare utilization. Annual mortality is estimated at 1% in patients with compensated cirrhosis without clinically significant portal hypertension and 57% in patients with decompensated cirrhosis as manifested by ascites and esophageal varices. Various models are present that can help in determining disease severity and prognosis with the Child-Pugh score and the Model for End-Stage Liver Disease (MELD) score being the most commonly used.