Diagnosis, Evaluation and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome

AASLD develops evidence-based practice guidelines and practice guidances which are updated regularly by a  multi-disciplinary panel of experts, including hepatologists, and include recommendations of preferred approaches to the diagnostic, therapeutic, and preventive aspects of care.

Practice Guidance

Hepatic decompensation, defined by ascites, hepatic encephalopathy, and portal hypertensive  gastrointestinal bleeding, is an important landmark in the natural history of cirrhosis. Ascites  is commonly the first decompensation-defining event, with 5%-10% of patients with compensated cirrhosis developing ascites per year. The development of ascites is associated with a reduction in 5-year survival from 80% to 30%, which is due in part to patients with ascites being prone to additional complications, such as bacterial infections, electrolyte abnormalities, HRS, and nutritional imbalances, and, consequently, further clinical decline. Patients with cirrhosis who develop clinically significant ascites and related complications  should be considered for referral for liver transplantation (LT) evaluation and, when appropriate, palliative care.

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome [updated August 2021]

Quality Measures on Cirrhosis

AASLD develops quality measures to help its members measure or quantify healthcare processes and outcomes that are associated with the ability to provide high-quality health care.

Learn More