Recompensation following first decompensation in patients with alcohol-related cirrhosis

BACKGROUND: The Baveno VII consensus recently introduced the term “recompensated cirrhosis,” but its prognostic relevance in alcohol-related cirrhosis remains unclear. This study aims to analyze the frequency and associated factors of recompensation in patients with alcohol-related cirrhosis following the first decompensation and evaluate the prognosis based on recompensation status. METHODS: This prospective cohort study was conducted at a tertiary care hospital in South Korea between 2017 and 2022. We enrolled 184 consecutive patients with alcohol-related cirrhosis presenting with a first decompensating event. According to the Baveno VII criteria, recompensation was defined as alcohol abstinence, improvement in liver function, and resolution of ascites/encephalopathy (off diuretics/lactulose) and absence of recurrent variceal bleeding (for at least 12 months). Patients were followed for outcomes including further decompensation, liver transplantation, or death. RESULTS: Of the 184 patients, 45 (24.5%) achieved abstinence-induced recompensation while 38 (20.6%) died during the index hospitalization. In the multivariable Fine-Gray competing risk regression analysis, a lower baseline Child-Pugh score (sHR = 0.77, 95% CI = 0.61–0.98, P = 0.032) and lower MELD score (sHR = 0.93, 95% CI = 0.88–0.99, P = 0.023) were independent factors associated with recompensation. Among the 146 survivors, 51 (34.9%) died, 10 (6.8%) underwent liver transplantation, and 95 (65.1%) experienced further decompensation. Time-dependent multivariable Cox regression analysis showed that recompensation decreased the risk of death or liver transplantation by 96% (HR = 0.04, 95% CI = 0.01–0.30, P = 0.002) and the risk of further decompensation by 75% (HR = 0.25, 95% CI = 0.13–0.48, P < 0.001). CONCLUSIONS: Approximately one-fourth of the patients with alcohol-related cirrhosis achieved recompensation after first decompensation, which was strongly associated with reduced mortality and lower risk of further decompensation.