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