Fibrosis and cirrhosis both happen because of liver damage due to factors such as excessive alcohol use, viral hepatitis, and obesity. Fibrosis is scarring of the liver. Scarring that is severe and permanent is called cirrhosis.

Liver disease affects an estimated 4.5 million adults in the United States, where it’s the ninth leading cause of death.

Fibrosis and cirrhosis result from liver disease. Fibrosis is scarring and stiffening of liver tissue. When this scarring becomes very severe and leads to permanent damage, it’s called cirrhosis.

While fibrosis and cirrhosis are very similar, they have some important distinctions. Keep reading to learn more about the similarities and differences between fibrosis and cirrhosis.

Fibrosis and cirrhosis can present differently.

Liver fibrosis symptoms

Most people with mild to moderate fibrosis have no symptoms. This means it’s possible to have some degree of liver damage and not be aware of it.

When fibrosis becomes very severe, healthcare professionals refer to it as cirrhosis. This is typically when you’ll start to experience symptoms.

Cirrhosis symptoms

As with fibrosis, some people with early cirrhosis may not have obvious symptoms. When symptoms of cirrhosis are present, they can include:

Fibrosis and cirrhosis have the same general causes, which are conditions that can cause injury to your liver. These include:

Causes of liver fibrosis

Liver fibrosis happens as a result of persistent inflammation that affects your liver. Liver inflammation is called hepatitis.

Inflammation stresses your liver and can cause injury or death of healthy liver cells. In response, cells in your liver make more collagen and other proteins to help repair the damage. But if inflammation continues over time, collagen and other proteins can continue to build up in your liver.

Eventually, this leads to stiffening and scarring that begins to replace healthy liver tissue.

Causes of cirrhosis

Cirrhosis is caused by prolonged, severe liver scarring that is permanent and significantly affects your liver’s ability to function. Cirrhosis is typically categorized as the last, most severe stage of fibrosis.

Because the basic causes of fibrosis and cirrhosis are the same, their risk factors are as well. These risk factors include:

Fibrosis and cirrhosis can affect your liver’s ability to function properly. This can lead to a variety of complications that can significantly affect your health.

The main complication of fibrosis is continued scarring that progresses to cirrhosis.

Cirrhosis can lead to complications such as:

Fibrosis and early cirrhosis often don’t cause many symptoms. However, it’s important to see a doctor if you notice:

  • lingering fatigue
  • loss of appetite or unintended weight loss
  • persistent upper right abdominal pain
  • frequent nausea or vomiting
  • itchy skin
  • very dark urine
  • pale stool
  • jaundice

These can all be symptoms of a liver issue. A doctor can help determine what’s causing your symptoms and recommend an appropriate treatment.

Generally, fibrosis requires a liver biopsy or a noninvasive imaging test called elastography or Fibroscan, which tests how stiff your liver tissue is.

A doctor will diagnose cirrhosis by looking at the bigger picture of your overall health. They will take your medical history, perform a physical exam, and order tests, which may include:

If the test results and the causes of your symptoms (such as heavy alcohol use or a hepatitis C infection) are clear, then a biopsy may not be necessary.

Liver fibrosis is scored based on how much scarring is in your liver. There are a few scoring systems, but one example is the Metavir scoring system, which scores fibrosis from 0 to 4.

A higher score means fibrosis is more severe. The scores generally break down as follows:

  • F0: no fibrosis
  • F1: mild fibrosis
  • F2: moderate fibrosis
  • F3: severe fibrosis
  • F4: cirrhosis

Healthcare professionals may approach the treatment of liver fibrosis and cirrhosis differently.

Liver fibrosis treatment

The Food and Drug Administration (FDA) has not approved any medications for fibrosis, according to a 2023 research review.

Instead, treatment focuses on addressing the cause of the fibrosis with the goal of slowing or stopping its progression. This can involve:

Cirrhosis treatment

As with fibrosis, the treatment of cirrhosis involves treating underlying causes.

Additional treatment can help address cirrhosis complications. These treatments can include:

A doctor may recommend a liver transplant if you meet certain conditions. Your eligibility will depend on many factors, such as your age, other medical conditions you have, and your ability to stick to a post-transplant treatment plan.

The outlook for fibrosis and cirrhosis can also differ.

Liver fibrosis life expectancy and outlook

Liver fibrosis is reversible if its underlying cause is treated. However, according to a 2020 review, when fibrosis is more advanced, this reversal is often too slow to avoid complications.

Generally, the outlook becomes less favorable as the severity of fibrosis increases. This is illustrated by a 2022 study in which researchers modeled a long-term outlook for NAFLD. They looked at life expectancy and mortality (death) risk at different stages of fibrosis for people with an average age of 49 years.

Fibrosis stageAdditional life expectancy10-year mortality due to liver disease10-year non-liver-related mortality
F0 (no fibrosis)25.3 years0.1%1.8%
F1 (mild)25.1 years0.2%2.4%
F2 (moderate)23.6 years1.0%5.2%
F3 (severe)21.1 years4.0%9.7%
F4 (cirrhosis)13.8 years29.3%15.6%

Cirrhosis life expectancy and outlook

Unlike the damage from fibrosis, damage that has occurred in cirrhosis is permanent and is not reversible. The outlook can depend on the type of cirrhosis.

If you have compensated cirrhosis, you may not seem to be ill. You might have no symptoms, or you might have mild symptoms such as fatigue, nausea, and upper right abdominal pain.

In decompensated cirrhosis, your liver has great difficulty functioning. You may have more severe symptoms, such as jaundice, and may experience cirrhosis complications.

A 2023 research article notes that the median survival is 12 years for compensated cirrhosis and 2 years for decompensated cirrhosis.

You can take several steps to help prevent fibrosis or cirrhosis, such as:

  • limiting your alcohol consumption or abstaining from alcohol completely
  • focusing on eating a nutritious, balanced diet
  • engaging in regular physical activity
  • making an effort to lose weight if you have obesity
  • taking all medications exactly as directed
  • getting vaccinated against hepatitis B
  • reducing your risk of viral hepatitis by avoiding contact with the blood or body fluids of others, such as by:
    • not sharing personal care items like razors or toothbrushes
    • not sharing injection needles or syringes

Now let’s answer some additional questions about fibrosis and cirrhosis.

What comes first, cirrhosis or fibrosis?

Liver fibrosis happens first. When liver fibrosis becomes severe and permanent and starts to affect liver function, it’s called cirrhosis.

How long does it take to progress from fibrosis to cirrhosis?

Progression of fibrosis to cirrhosis is typically slow. It can often take around 20 years for cirrhosis to develop.

Can you have fibrosis without cirrhosis?

Yes. There are different stages of fibrosis. The specific stages can depend on the scoring system used, but generally the severity of fibrosis increases as the stage increases. Cirrhosis is typically the last (highest) stage of fibrosis.

How serious is fibrosis of the liver?

Fibrosis of the liver can become serious if it progresses to cirrhosis. At that point, irreversible liver damage has occurred and can cause a variety of health problems.

Is liver fibrosis reversible?

Yes. If you identify and treat it early, it’s possible to reverse liver fibrosis.

Fibrosis and cirrhosis both happen when your liver is damaged over time. Underlying causes include excessive alcohol consumption, viral hepatitis, and autoimmune conditions.

Fibrosis is liver scarring. Cirrhosis is liver scarring that is severe and permanent and significantly affects liver function.

Liver disease can lead to serious and life threatening complications. Consult a doctor if you have symptoms such as persistent upper right abdominal pain, frequent nausea and vomiting, or jaundice.