Background: The Baveno VII consensus recently introduced the term “recompensated cirrhosis,” but its prognostic relevance in alcohol-related cirrhosis remains unclear. This study aims to analyze the frequency and associated factors of recompensation in patients with alcohol-related cirrhosis following the first decompensation and evaluate the prognosis based on recompensation status. Methods: This prospective cohort study was conducted at a tertiary care hospital in South Korea between 2017 and 2022. We enrolled 184 consecutive patients with alcohol-related cirrhosis presenting with a first decompensating event. According to the Baveno VII criteria, recompensation was defined as alcohol abstinence, improvement in liver function, and resolution of ascites/encephalopathy (off diuretics/lactulose) and absence of recurrent variceal bleeding (for at least 12 months). Patients were followed for outcomes including further decompensation, liver transplantation, or death. Results: Of the 184 patients, 45 (24.5%) achieved abstinence-induced recompensation while 38 (20.6%) died during the index hospitalization. In the multivariable Fine-Gray competing risk regression analysis, a lower baseline Child-Pugh score (sHR = 0.77, 95% CI = 0.61–0.98, P = 0.032) and lower MELD score (sHR = 0.93, 95% CI = 0.88–0.99, P = 0.023) were independent factors associated with recompensation. Among the 146 survivors, 51 (34.9%) died, 10 (6.8%) underwent liver transplantation, and 95 (65.1%) experienced further decompensation. Time-dependent multivariable Cox regression analysis showed that recompensation decreased the risk of death or liver transplantation by 96% (HR = 0.04, 95% CI = 0.01–0.30, P = 0.002) and the risk of further decompensation by 75% (HR = 0.25, 95% CI = 0.13–0.48, P < 0.001). Conclusions: Approximately one-fourth of the patients with alcohol-related cirrhosis achieved recompensation after first decompensation, which was strongly associated with reduced mortality and lower risk of further decompensation.

Background: Hypoxic hepatitis contributes to the development and progression of multiple organ failure (MOF). We evaluated whether MOF is associated with 30-day mortality in patients with hypoxic hepatitis. Methods: This retrospective study included 1011 patients diagnosed with hypoxic hepatitis at two centers in South Korea between 2010 and 2021. Organ failure was defined as a sequential organ failure assessment score ≥ 3 for each individual organ system. Results: Circulatory failure was the most common organ failure (n = 521), followed by respiratory (n = 380), cerebral (n = 307), renal (n = 236), coagulation (n = 182), and hepatic failure (n = 73). The proportions of patients without organ failure, with single organ failure, and with MOF were 28.7%, 22.3%, and 49.1%, respectively, with corresponding 30-day mortality rates of 17.9%, 29.3%, and 70.0%. In the multivariate Cox regression model, the presence of MOF grade 1 (two organ failures), grade 2 (three organ failures), and grade 3 (≥four organ failures) increased the risk of 30-day mortality by approximately threefold, fourfold, and fivefold, respectively, compared to patients without MOF. Conclusions: MOF is frequently observed in patients with hypoxic hepatitis and is a strong independent predictor of short-term mortality.