Liver cirrhosis: epidemiology, risk factors, potential complications, and possible treatment strategies

In 2025, liver cirrhosis, characterized by hepatic fibrosis and regenerating nodules, with over 185 million individuals infected globally (>3% of the world population), represented a significant global health challenge, with hepatitis B virus (HBV) being the primary cause. This review synthesizes the epidemiology, risk factors, consequences, and therapies of cirrhosis. The hepatitis B virus (HBV) is predominantly prevalent in the Asia-Pacific region, but in Western countries, HCV, alcohol misuse, and non-alcoholic fatty liver disease (NAFLD)—exacerbated by rising obesity rates—predominate. Additional risk factors exacerbate disease progression, including diabetes and familial predisposition. Cirrhosis progresses via compensated and decompensated stages; decompensation signifies severe outcomes such as variceal hemorrhage, hepatic encephalopathy (HE), hepatocellular carcinoma (HCC), hepatorenal syndrome, and bacterial peritonitis. Pathophysiological mechanisms include chronic inflammation leading to HCC, variceal rupture due to portal hypertension, and neurotoxicity from hyperammonemia in HE. Current treatment emphasizes etiology-specific techniques such as alcohol abstinence, NAFLD prevention, and antiviral therapies for HBV/HCV. While modifications to gut microbiota and nutritional supplementation target systemic inflammation and malnutrition, innovative strategies such as mesenchymal stromal cell therapy aim to rebuild hepatocytes. Liver transplantation, despite constraints in organ availability, is crucial for end-stage disease management. Despite advancements, the molecular mechanisms behind fibrosis and cirrhosis require further elucidation before the development of targeted therapies. Mitigating the global burden of cirrhosis necessitates addressing regional disparities in risk factors and healthcare accessibility. This analysis underscores the necessity of interdisciplinary, etiology-specific approaches to enhance therapy outcomes and reduce mortality in cirrhotic patients. • Over 185 million individuals were infected globally by liver cirrhosis, with hepatitis B (HBV) as the leading etiology. • Risk factors vary regionally: HBV dominates in Asia-Pacific, while HCV, alcohol, and NAFLD prevail in Western countries. • Disease progression involves compensated and decompensated stages, with decompensation increasing mortality by 80% within a year. • Major complications include hepatocellular carcinoma, variceal bleeding, hepatic encephalopathy, and hepatorenal syndrome. • Emerging therapies like mesenchymal stromal cell transplantation and gut microbiome modulation offer promising avenues for managing cirrhosis.