Table 1.
Decompensated cirrhosis consensus summary
| Problem | Recommendations |
| Volume status and end points of resuscitation | MAP, TTE, and PAC measurements more reliable than pulse pressure variation or arterial pulse contour |
| SvO2 and serum lactate can be inaccurate | |
| Fluid resuscitation and vasopressors | Balanced salt solutions recommended over normal saline |
| Norepinephrine=pressor of choice | |
| Albumin useful in SBP, HRS, and PPCD | |
| Ascites management | Preoperative |
| Grade 2 ascites: Na+ restriction and diuretics | |
| Grade 3: large volume paracentesis | |
| Consider preoperative TIPS | |
| Postoperative | |
| Consider postoperative TIPS | |
| No recommendation for fluids or drains | |
| Hepatorenal syndrome | Volume expansion with albumin, treatment of infections, stopping diuretics |
| MAP >65 mm Hg with norepinephrine versus terlipressin | |
| GI bleeding | Ceftriaxone plus vasoactive agent (vasopressin, somatostatin, or octreotide) |
| Endoscopy within 12 hours | |
| TIPS for recurrent or persistent variceal bleed | |
| Coagulopathy | VTE prophylaxis should follow standard of care; can follow viscoelastic testing |
| Empiric platelet transfusions not indicated for peri-procedural correction of thrombocytopenia | |
| Hepatic encephalopathy | Ammonia can exclude but should not be followed as end point |
| Treatment with non-absorbable disaccharides and rifaximin | |
| Nutrition | Early enteral nutrition preferred; protein restriction not beneficial |
| Hypoglycemia should be aggressively managed | |
| Prognosis | Clinical scores include MELD, ACLF criteria, CLIF-SOFA |
| Biomarkers being investigated include cystatin C, copeptin, procalcitonin, and CRP |
ACLF, Acute-on-Chronic Liver Failure; CLIF-SOFA, Chronic Liver Failure-Sequential Organ Failure Assessment; CRP, C reactive protein; GI, gastrointestinal; HRS, hepatorenal syndrome; MAP, mean arterial pressure; MELD, Model of End-Stage Liver Disease; Na+, sodium; PAC, pulmonary artery catheter; PPCD, postparacentesis circulatory dysfunction; SBP, spontaneous bacterial peritonitis; SvO2, central venous oxygenation level; TIPS, transjugular intrahepatic portosystemic shunt; TTE, transthoracic echocardiography; VTE, venous thromboembolism.