Outcomes of first and further decompensation events in advanced chronic liver disease: a multi-centre competing risks...

Decompensated cirrhosis carries a significant health burden with high mortality. The aim of this study was to assess incidence of further decompensation and survival in patients with cirrhosis following hospitalization with initial decompensation.

Adult patients with cirrhosis at three Australian state-wide liver transplant centres from 2006 to 2025, admitted to hospital with a first decompensating event (ascites, hepatic encephalopathy, variceal bleeding) and followed until further decompensation requiring hospitalisation, liver-related death (LRD), non-liver related death, or liver transplant (LT).

A total of 542 patients were followed from first decompensation for a median of 24 (IQR 9-48) months, with alcohol-related liver disease the most common etiology (52%). Cumulative incidence of further decompensation at 5-years was 65.1% (95% CI 60.3-69.5), and incidence of LRD or LT was 39.2% (95% CI 34.1-44.2). Following further decompensation, cumulative incidence of LRD or LT was higher compared to first decompensation at 55.5% (sHR 3.45, 95% CI 2.31-5.16, p < 0.001). Ascites was the most common type of further decompensation (35.6%, 95% CI 31-40.2). Etiological treatment of the underlying CLD was protective for further decompensation and LRD/LT (sub hazard ratio [sHR] 0.58 and 0.65 respectively, p < 0.05), as was treatment with a non-selective beta blocker (sHR 0.40 and 0.60, p < 0.01).

This multi-centre study describes the trajectory of patients after a first episode of decompensation for the first time in the Australian context. It highlights high morbidity and poor prognosis associated with further decompensation with over 50% dying or requiring LT within 5 years.