• Risk Factors for Cirrhosis

    A risk factor is something that increases your likelihood of getting a disease or condition.
    It is possible to develop cirrhosis with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing cirrhosis. If you have risk factors for cirrhosis, ask your doctor what you can do to reduce your risk. Even one or two risk factors is reason enough to consult a provider.

    Chronic Alcohol Abuse

    Although only about a third of chronic alcoholics develop cirrhosis, between 75%-80% of cirrhosis cases could be prevented by eliminating alcohol abuse. Alcoholic cirrhosis usually develops after ten or more years of heavy drinking.
    The amount of alcohol consumption that produces cirrhosis varies widely, with as few as 2-4 drinks per day resulting in damage to some people. Compared with men, women appear to be more susceptible to cirrhosis at lower alcohol intakes.
    In general, though, the more you drink, the more likely that you will develop cirrhosis. Alcohol is toxic to liver cells. It also damages the liver by altering normal metabolism of proteins, fats, and carbohydrates. Chronic alcoholics also tend to have poor quality diets, which may contribute to the development of cirrhosis.

    Medical Conditions

    Chronic Infection with Hepatitis B, C, or D
    Some acute viral hepatitis infections become chronic, leading to liver inflammation and injury that, over time, progress to cirrhosis. After alcohol related cirrhosis, the National Digestive Diseases Information Clearinghouse (NDDIC/NIH) notes that chronic "hepatitis C virus ranks with alcohol as a major cause of chronic liver disease and cirrhosis in the United States."
    • Infection with the hepatitis B virus is probably the most common cause of cirrhosis worldwide, although its impact is less pronounced in the US and other western countries. World Health Organization (WHO) statistics show that 2 billion individuals are initially infected with hepatitis B virus, and although the majority recover, "350 million remain infected chronically and become carriers of the virus." Other expert sources state that acute infection with hepatitis B leads to chronic infection in about 5% of persons. The rate of hepatitis B infection is highest among Asians and Pacific Islanders and second highest among non-Hispanic blacks.
    • Acute infection with hepatitis C becomes chronic in about 80% of infected adults. About 20%-30% of people with chronic hepatitis C will develop cirrhosis, usually over many years. The rate of hepatitis C infection is highest among non-Hispanic blacks.
    • Hepatitis D infects people who are already infected with hepatitis B.
    • Acute hepatitis A and hepatitis E do not usually lead to chronic hepatitis and so have little impact on the development of cirrhosis. There can be rare exceptions to any general rule, however.
    Nonalcoholic Steatohepatitis (NASH)
    In this disorder, fat cells build up in the liver and eventually lead to scarring. This type of hepatitis is associated with:
    • Diabetes
    • Obesity
    • Gaining weight
    • High triglyceride blood levels
    • Coronary artery disease
    • Intestinal bypass surgery
    • Long-term treatment with corticosteroids
    Secondary Bilary Cirrhosis
    Blockage of the bile ducts causes bile to back up and damage liver tissue. In adults, this can occur with a condition called primary biliary cirrhosis, in which the bile ducts become inflamed, blocked, and scarred.
    Bile ducts may also be blocked due to a disease called primary sclerosing cholangitis. It can also occur as a result of gallstones, or as a complication of gallbladder surgery if the ducts are accidentally tied off or injured. It can result from inflammation of the pancreas, called pancreatitis. In infants, blocked bile ducts may result from biliary atresia, a condition in which the bile ducts are injured or totally absent from birth.
    Hepatic Congestion
    Conditions such as heart failure or constrictive pericarditis can cause congestion within the liver leading to cirrhosis.
    Inherited Disorders
    Numerous inherited disorders interfere with the way the liver produces, processes, and stores enzymes, proteins, metals, and other substances necessary for proper functioning of the body. They include:
    • Hemochromatosis—an inherited disorder that causes the body to absorb and store too much iron, which builds up in various organs, including the liver, and causes damage
    • Wilsons disease—an inherited disorder that results in excessive copper accumulation in the body, which also can produce liver damage
    • Alpha-1 antitrypsin deficiency—an inherited deficiency of a protein produced in the liver that normally functions to block the destructive effects of certain enzymes; may lead to liver disease and emphysema
    • Galactosemia—an inherited disorder characterized by the inability of the body to use the simple sugar galactose; leads to an accumulation of galactose 1-phosphate, which causes damage to the liver, central nervous system, and various other body systems
    • Glycogen storage diseases—a group of inherited disorders caused by a lack of one or more enzymes that results in excessive storage of glycogen (a glucose polymer) in the liver and eventual liver damage
    • Cystic fibrosis—a genetic disorder the can result in liver damage, including cirrhosis
    • Budd-Chiari syndrome—a condition caused by a blood clot which blocks the veins that carry blood from the liver into the inferior vena cava. The vena cava is the large vein which carries blood from the left side of our body back to the heart.
    Autoimmune Hepatitis
    This is a condition in which immune cells mistake normal liver cells as invading cells and attack them. Eventually, this leads to cirrhosis.


    You are more likely to develop cirrhosis as you get older. This is because you have had more years to expose your liver to viruses, toxins, and medical conditions that cause cirrhosis.

    Other Factors

    The following factors can lead to liver damage that is severe enough to cause cirrhosis:
    • Severe adverse reactions to prescription drugs, such as isoniazid and methotrexate
    • Chronic exposure to environmental toxins such as arsenic
    • Severe excesses of vitamin A
    • Repeated episodes of heart failure with liver congestion
    • The parasitic infection schistosomiasis


    American Liver Foundation website. Available at: http://www.liverfoundation.org. Accessed March 8, 2006.

    Heidelbaugh JJ, Bruderly M. Cirrhosis and Chronic Liver Failure: Part I. Diagnosis and Evaluation. Am Fam Physician. 2006;74:756-762.

    National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov. Accessed March 7, 2006.

    National Library of Medicine website. Available at: http://www.nlm.nih.gov. Accessed March 8, 2006.

    2/12/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Chang Y, Ryu S, et al. Weight gain within the normal weight range predicts ultrasonographically detected fatty liver in healthy Korean men. Gut. 2009;58(10):1419-1425.

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