The impact of non-acute decompensation of cirrhosis on patient mortality.

BACKGROUND AND AIMS Cirrhosis progression from compensated to decompensated stage signals a deterioration in prognosis, with episodes of acute decompensation (AD) carrying a high risk of short-term mortality. Recently, the concept of non-acute decompensation (NAD) has emerged, representing a more insidious form of decompensation that is nonetheless associated with increased mortality. We aimed to evaluate the clinical impact of NAD in a hospital-referred hepatology population.

METHODS Single-center, retrospective, longitudinal observational study which included adult patients with compensated cirrhosis followed between 2013-2025.

RESULTS Data from 391 patients were analyzed, 72.1% male with a mean age of 59.9±11 years. Of those, 215 did not decompensate (ND), 121 developed NAD and 55 developed AD. The baseline independent predictors of NAD included a higher MELD score, lower serum albumin and non-compliance with the effective etiological treatment. AD was predicted by lower serum albumin, lower platelet count and non-compliance with the effective etiological treatment. Mortality was significantly higher in NAD (HR 10.82; p<0.001) and AD (HR 21.47; p<0.001) when compared with ND.

CONCLUSIONS Our data shows that both AD and NAD are independent predictors of mortality in cirrhosis, with the former associating more significantly than the latter. However, the occurrence of NAD, despite clinically silent, should be recognized as marker of poor prognosis.