Predicting Recompensation in Alcohol, HBV and HCV-associated Decompensated Cirrhosis

Area of Science:

• Hepatology
• Internal Medicine
• Gastroenterology

Background:

• Recompensation signifies sustained clinical improvement in decompensated cirrhosis after etiological treatment.
• Predicting recompensation aids prognostication in clinical hepatology practice.

Purpose of the Study:

• To identify baseline predictors of recompensation in patients with alcohol-associated liver disease (ALD) or viral (HBV/HCV) decompensated cirrhosis.
• To compare recompensation rates across different etiologies and assess the role of clinical, laboratory, and imaging parameters.

Main Methods:

• Retrospective study of 244 patients with decompensated cirrhosis (ALD, HBV, HCV) receiving etiology-specific treatment.
• Data collected included demographics, MELD score, bilirubin, INR, liver stiffness measurement (LSM), and CT-derived sarcopenia and bone density.
• Fine-Gray competing risk regression was used, considering death, HCC, and liver transplantation as competing events.

Main Results:

• Recompensation achieved in 28.7% of patients over median 38 months follow-up; more frequent in HBV (42%) and HCV (35.6%) vs ALD (14.4%).
• Recompensated patients had lower baseline MELD, bilirubin, and INR. Higher platelet count, absence of jaundice, and HBV etiology independently predicted recompensation.
• Lower LSM and reduced sarcopenia/osteopenia were observed in recompensated patients.

Conclusions:

• Recompensation occurs in approximately one-fourth of decompensated cirrhosis patients, with higher rates in viral etiologies.
• Baseline factors like higher platelet count and absence of jaundice are significant independent predictors of recompensation.