Clinical and pathophysiological characteristics of non acute decompensation of cirrhosis

This study evaluated non-acute decompensation (NAD) as a distinct clinical phenotype of cirrhosis characterised by gradual development of complications without acute decompensation. Among 541 patients, 311 had NAD, 29 had compensated cirrhosis, and 201 had acute decompensation (AD).

Patients with NAD had an intermediate prognosis, with 12-month survival of 81.7%, compared with 100% in compensated cirrhosis and 31.2% in AD. During 12 months of follow-up, 41.8% progressed to AD. NAD was associated with increased markers of cell death, but not significant systemic inflammation. Severe ascites, higher bilirubin, elevated gasdermin D and RIPK3, and lower IGF-1 predicted progression to AD.

Overall, the study suggests that NAD is a distinct and clinically important stage of cirrhosis, with specific biological features and predictors of deterioration.