Refining Prognosis in Cirrhosis Patients With Ascites: Impact of Acute vs. Non‐Acute Decompensation

作者：Lucie Simonis, Lorenz Balcar, Anna Schedlbauer, Marta Tonon, Nikolaj Torp, Valeria Santori, Katharina Stopfer, Jan Embacher, Christian Sebesta, Leonie Hafner, Benedikt Hofer, Nina Dominik, Georg Kramer, Paul Thöne, Michael Trauner, Aleksander Krag, Salvatore Piano, Mattias Mandorfer, Thomas Reiberger, Georg Semmler · 发表于：Alimentary Pharmacology & Therapeutics · 年份：2025 · DOI：10.1111/apt.70302 · 被引用次数：5 · 研究领域：Liver Disease and Transplantation、Sepsis Diagnosis and Treatment、Organ Transplantation Techniques and Outcomes

BACKGROUND: A more granular understanding of hepatic decompensation in cirrhosis has led to the classification of acute decompensation (AD) and non-acute decompensation (NAD). In this study, we assessed differences in the clinical course of AD versus NAD in patients with ascites as the first decompensation event. METHODS: 505 cirrhosis patients with ascites as first decompensation were included in this single-center longitudinal cohort study and followed until further decompensation, orthotopic liver transplantation (OLT), or death. AD was defined as grade 3 ascites or ascites with spontaneous bacterial peritonitis (SBP) or acute-kidney injury (AKI), while NAD was defined as grade 2 ascites. Hospitalisation was recorded. RESULTS: Among 505 patients, 296 (58.6%) met the criteria for AD, with 216 (73.0%) requiring hospitalisation. NAD occurred in 209 (41.4%), with 107 (51.2%) requiring hospitalisation. During a median 4.4-year follow-up, further decompensation occurred in 65.1%, acute-on-chronic liver failure (ACLF) in 27.7%, 10.9% underwent OLT, and 51.1% died. Patients with AD had a higher incidence of further decompensation (at 12 months: 19% and 33%) and a higher risk of transplant-free mortality (subdistribution hazard ratio [SHR]: 1.43 [95% CI: 1.12-1.82], p = 0.004) versus NAD. When stratified by hospitalisation, AD was associated with an increased risk of mortality only in cases requiring hospitalisation (SHR for hospitalised AD vs. non-hospitalised NAD: 1.89, 95% CI: 1...