Etiological cure prevents further decompensation and mortality in patients with cirrhosis with ascites as the single first decompensating event

Background and Aims: Removal/suppression of the primary etiological factor reduces the risk of decompensation and mortality in compensated cirrhosis. However, in decompensated cirrhosis, the impact of etiologic treatment is less predictable. We aimed to evaluate the impact of etiological treatment in patients with cirrhosis who developed ascites as single index decompensating event.Approach and Results: Patients with cirrhosis and ascites as single first decompensation event were included and followed until death, liver transplantation, or Q3/2021. The etiology was considered cured (alcohol abstinence, hepatitis C cure, and hepatitis B suppression) versus controlled (partial removal of etiologic factors) versus uncontrolled. A total of 622 patients were included in the study. Etiology was cured in 146 patients (24%), controlled in 170 (27%), and uncontrolled in 306 (49%). During follow-up, 350 patients (56%) developed further decompensation. In multivariable analysis (adjusted for age, sex, varices, etiology, Child-Pugh class, creatinine, sodium, and era of decompensation), etiological cure was independently associated with a lower risk of further decompensation (HR: 0.46; p = 0.001). During follow-up, 250 patients (40.2%) died, while 104 (16.7%) underwent LT. In multivariable analysis, etiological cure was independently associated with a lower mortality risk (HR: 0.35, p < 0.001).Conclusions: In patients with cirrhosis and ascites as single first decompensating event, the cure of liver disease etiology represents a main treatment goal since this translates into considerably lower risks of further decompensation and mortality.

Automated summary

In cirrhotic patients who develop ascites as the first decompensation event, curing the etiology of liver disease is a crucial treatment goal as it significantly reduces the risks of further decompensation and mortality.