A Retrospective Analysis of Hepatic Disease Burden and Progression in a Hospital-Based Romanian Cohort Using Integrated Cross-Sectional and Longitudinal Data (2019–2023)

<b>Objective:</b> To analyze demographic traits, clinical complications, and healthcare use in patients with chronic liver disease across major etiologies in a large Romanian cohort. <b>Methods:</b> A retrospective study (2019-2023) of 2359 patients with chronic hepatitis C (CHC), hepatitis associated with alcohol (ALH), cirrhosis associated with alcohol (ALC), or non-alcoholic cirrhosis (NALC). Data on demographics, clinical outcomes, and hospitalizations were analyzed using descriptive statistics, regression modeling, and clustering in IBM SPSS 27.0.1. <b>Results:</b> CHC patients were oldest (mean 67.5 ± 12.3 years), while ALH patients were youngest (56.0 ± 11.0 years). CHC prevalence increased with age (10.0% in ≤30-year-olds to 87.1% in ≥81-year-olds; γ = 0.535, <i>p</i> < 0.001). Females comprised 60-70% of CHC cases, males > 85% of ALH and >78% of ALC. Mean hospitalization duration decreased from 13.80 days (2019) to 9.10 days (2023), yet cirrhotic patients had the longest stays (NALC: 16.37 ± 14.34; ALC: 17.66 ± 12.96) versus CHC (10.38 ± 10.14). Etiology was the strongest predictor of hospitalization length. Portal hypertension (PH) was the most common complication (54.3%), with males bearing more severe hepatic complications (ascites-38.3%; PH-66.8%). <b>Conclusions:</b> Hospital-based Romanian cohort analysis revealed that patient presentation and outcomes are fundamentally shaped by the interplay of etiology, sex, and age. We found a distinct female predominance in CHC, a pronounced male predominance in alcohol-related diseases, and evolving trends in non-alcoholic cirrhosis. These determinants dictate specific epidemiological patterns, hospitalization burdens, and complication risks, underscoring the critical need for a paradigm shift toward personalized, etiology-driven, and sex-tailored clinical management.