Chronic Liver Disease Definition and Characteristics
Core Characteristics and Etiologies
- Chronic liver disease is defined as cirrhosis (clinically suspected or histologically proved) or the presence of severe cholestatic liver disease with a serum bilirubin level more than three times the upper limit of normal for more than six months, according to the American Gastroenterological Association 1
- Chronic liver disease encompasses a variety of causes of chronic liver injury that can progress to hepatic fibrosis and cirrhosis, with associated complications of portal hypertension, gastrointestinal hemorrhage, refractory ascites, hepatic encephalopathy, and primary liver cancer, as stated by the American College of Radiology 2
- The progression of hepatic fibrosis to compensated cirrhosis to decompensated cirrhosis can be slow and clinically silent, often making early diagnosis challenging, as noted by the American College of Radiology 2
- Nonalcoholic fatty liver disease (NAFLD)/Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most common cause of chronic liver disease worldwide, according to the European Association for the Study of Diabetes and the American Gastroenterological Association 3, 4
- Viral hepatitis (hepatitis B, hepatitis C) is a major etiology of chronic liver disease, as stated by the American College of Radiology 2
- Alcohol-related liver disease is another significant etiology of chronic liver disease, as noted by the American College of Radiology 2
- Autoimmune liver diseases (autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis) are also important etiologies of chronic liver disease, as stated by the American College of Radiology 2
Disease Spectrum and Progression
- In MASLD specifically, the spectrum includes steatosis, metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, cirrhosis, and MASH-related hepatocellular carcinoma, according to the European Association for the Study of Diabetes 3
- Acute-on-chronic liver failure (ACLF) represents a severe complication characterized by acute deterioration in clinical condition, liver failure (elevated bilirubin and INR), and at least one extrahepatic organ failure in patients with chronic liver disease, as defined by the American Association for the Study of Liver Diseases 5
Diagnostic Approaches
- Liver biopsy remains the reference standard for diagnosis but is costly, subject to sampling errors, and not well accepted for longitudinal disease monitoring, as stated by the American College of Radiology 2