The clinical course of cirrhosis is mostly determined by the progressive increase of portal hypertension, hyperdynamic circulation, bacterial translocation and activation of systemic inflammation. Different disease states, encompassing compensated and decompensated cirrhosis and a late decompensated state, are related to the progression of these mechanisms and may be recognised by haemodynamic or clinical characteristics. While these disease states do not follow a predictable sequence, they correspond to varying mortality risk. Acute-on-chronic liver failure may occur either in decompensated or in compensated cirrhosis and is always associated with a high short-term mortality. The increasing severity of these disease states prompted the concept of clinical states of cirrhosis. A multistate approach has been considered to describe the clinical course of the disease. Such an approach requires the assessment of the probabilities of different outcomes in each state, which compete with each other to occur first and mark the transition towards a different state. This requires the use of competing risks analysis, since the traditional Kaplan-Meier analysis should only be used in two-state settings. Accounting for competing risks also has implications for prognosis and treatment efficacy research. The aim of this review is to summarise relevant clinical states and to show examples of competing risks analysis in multistate models of cirrhosis.

中文翻译：

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肝硬化的临床状态和竞争风险

肝硬化的临床病程多由门静脉高压逐渐加重、高动力循环、细菌易位和全身炎症激活决定。不同的疾病状态，包括代偿性和失代偿性肝硬化以及晚期失代偿状态，与这些机制的进展有关，可以通过血流动力学或临床特征来识别。虽然这些疾病状态不遵循可预测的顺序，但它们对应于不同的死亡风险。急性慢性肝衰竭可能发生在失代偿期或代偿期肝硬化中，并且总是与高短期死亡率相关。这些疾病状态的日益严重促使了肝硬化临床状态的概念。已考虑采用多态方法来描述疾病的临床过程。这种方法需要评估每个状态中不同结果的概率，这些结果相互竞争首先发生并标志着向不同状态的过渡。这需要使用竞争风险分析，因为传统的 Kaplan-Meier 分析应该只用于两种状态的设置。考虑竞争风险也对预后和治疗效果研究有影响。本综述的目的是总结相关的临床状态，并展示肝硬化多状态模型中竞争风险分析的例子。它们相互竞争首先发生并标志着向不同状态的过渡。这需要使用竞争风险分析，因为传统的 Kaplan-Meier 分析只应在两种状态下使用。考虑竞争风险也对预后和治疗效果研究有影响。本综述的目的是总结相关的临床状态，并展示肝硬化多状态模型中竞争风险分析的例子。它们相互竞争首先发生并标志着向不同状态的过渡。这需要使用竞争风险分析，因为传统的 Kaplan-Meier 分析只应在两种状态下使用。考虑竞争风险也对预后和治疗效果研究有影响。本综述的目的是总结相关的临床状态，并展示肝硬化多状态模型中竞争风险分析的例子。