Eficacia del manejo paliativo de enfermería centrado en la comunidad versus atención hospitalaria estándar en pacientes con cirrosis hepática descompensada: Revisión sistemática

DOI: https://doi.org/10.46296/yc.v10i19.1006 Abstract Hepatic cirrhosis is a chronic, progressive, and irreversible condition characterized morphophysiologically by the diffuse replacement of functional parenchyma with a dense fibrillar extracellular matrix and abnormally structured regenerative nodules; this drastically alters internal vascular architecture and sinusoidal microcirculation. This structural distortion increases resistance to portal blood flow, triggering clinically significant portal hypertension defined by a hepatic venous pressure gradient exceeding 10 mm Hgwhich acts as the central pathophysiological driver of the most severe clinical manifestations. Epidemiologically, cirrhosis is a leading cause of morbidity and mortality in adults worldwide, driven primarily by sustained harmful alcohol consumption, chronic hepatitis B and C viral infections, and the marked rise in metabolic dysfunction-associated fatty liver disease, alongside less common but complex etiologies such as autoimmune hepatitis, Wilson's disease (copper accumulation), and hereditary hemochromatosis (iron overload). The disease's clinical course progresses from a prolonged, often asymptomatic compensated phase to decompensated stages characterized by the onset of serious complications that drastically compromise short- and medium-term survival. Key decompensation events include ascites, spontaneous bacterial peritonitis resulting from bacterial translocation, gastroesophageal varices carrying a high risk of massive gastrointestinal hemorrhage, hepatic encephalopathy induced by the systemic accumulation of neurotoxins (such as ammonia), hepatorenal syndrome, and eventual progression to hepatocellular carcinoma. In this complex clinical landscape, multidisciplinary and interdisciplinary palliative care stands as an essential component that should not be deferred until the terminal phase but rather integrated early into the patient's ongoing management. Nursing interventions focused on the community and home environment play a pivotal role in alleviating the physical, psychosocial, and spiritual suffering of both the patient and their support network. In the physical realm, nursing care encompasses close hemodynamic monitoring; pharmacological and non-pharmacological management of intractable pain and chronic fatigue; rigorous monitoring of fluid and electrolyte balance; high-protein, high-calorie nutritional support aimed at preventing or counteracting sarcopenia and protein-calorie malnutrition; and the performance of invasive palliative procedures such as the peritoneal drainage of refractory ascites within the community setting. In the psychosocial sphere, nursing fosters the strengthening of family and social support networks, provides ongoing health education for self-care, promotes effective coping mechanisms, and actively prevents caregiver burden or burnout through the equitable redistribution of daily responsibilities. Furthermore, the spiritual dimension is crucial for providing existential comfort, deeply respecting the patient's worldview, rituals, and individual beliefs, while facilitating opportunities for dialogue, reconciliation, and emotional closure. In conclusion, scientific evidence demonstrates that a holistic, humanized, and structured approach by the community nursing team optimizes symptom control, reduces unplanned hospital readmissions, preserves human dignity, and positively transforms the quality of life for patients with advanced liver disease and their families. Keywords: Liver cirrhosis; Palliative care; Nursing; Portal hypertension; Complications; Quality of life; Psychosocial support; Sarcopenia.