A 48-year-old man with a 10-year history of nonalcoholic fatty liver disease complicated by cirrhosis presents to the clinic with progressive dyspnea, lower extremity edema, and abdominal distension over the past 3 weeks. His wife notes he has been increasingly fatigued and reports orthopnea. Vital signs: BP 128/76 mmHg, HR 102 bpm, RR 24/min, SpO2 91% on room air. Physical examination reveals anasarca, hepatomegaly, ascites, bilateral basilar crackles, and a prominent S3 gallop. Laboratory studies show serum albumin 2.1 g/dL, total bilirubin 3.2 mg/dL, INR 1.8, creatinine 1.0 mg/dL (baseline 0.9), and BNP 520 pg/mL. Abdominal ultrasound confirms cirrhosis with patent portal vein. He denies fever, abdominal pain, or recent alcohol use. Which of the following best explains his acute clinical deterioration?

1. A)Spontaneous bacterial peritonitis with systemic inflammatory response
2. B)Portal vein thrombosis with acute splanchnic congestion
3. C)Hepatorenal syndrome Type 1 with oliguria and rising creatinine
4. D)Progressive hepatic decompensation with worsening synthetic function alone
5. E)Superimposed heart failure with elevated filling pressures and pulmonary edemaGABARITO