The rate and predictors of recompensation in patients with decompensated cirrhosis due to metabolic dysfunction–associated liver disease (MASLD)

BACKGROUND: Whether patients with metabolic dysfunction-associated steatotic liver disease (MASLD) cirrhosis can achieve recompensation is still a subject of debate. This study aimed to evaluate the incidence and factors associated with recompensation in patients with decompensated MASLD cirrhosis. METHODS: Cohort study across 4 university hospitals in Barcelona (Spain), enrolling individuals with MASLD cirrhosis at their initial decompensating event. Liver recompensation (Baveno VII) was defined as the absence of clinical decompensation after discontinuation of specific treatment, along with sustained improvement in liver function. Competing-risk regression models were used to identify predictors of recompensation. RESULTS: Among 124 patients [mean age: 69 years (IQR 62-73), 53% males], 59% had obesity, 74% type 2 diabetes, 66% arterial hypertension, and 47% dyslipidemia. Most patients were Child-Pugh B (61%) with a median MELD-Na score of 11 (IQR 10-16). After a median follow-up of 2.1 years (IQR 0.97-4.53), the 2-year cumulative incidence of recompensation was 24%. Factors associated with recompensation included MELD-Na (aSHR 0.891 [95% CI 0.833-0.953]; p=0.001), albumin (aSHR 1.894 [95% CI 1.008-3.297]; p=0.024, ascites (aSHR 0.475, [95% CI 0.268-0.841]; p=0.011), and multiple decompensation (aSHR 0.151 [94% CI 0.033-0.698]; p=0.015) as a first decompensation event. Although a substantial proportion of patients initially achieved recompensation, this was frequently transient, and its apparent survival benefit did not persist after adjustment for liver function and accounting for time-dependence. CONCLUSIONS: Liver recompensation in MASLD cirrhosis occurs in 24% of patients within 2 years after first decompensation and is mainly dependent on basal liver function. However, frequent further decompensation limits its prognostic impact on survival.