Incidence and predictors of acute decompensation in adult patients with cirrhosis: a retrospective cohort study at the University of Gondar comprehensive Specialized Hospitals, Northwest Ethiopia, 2025

Cirrhosis with its acute decompensation and its complications causes significant morbidity and mortality. It also markedly reduces the quality of life and is by far the main reason for repeated hospitalization in patients with cirrhosis. There is also global disparity in mortality rate, which is higher in developing countries than developed countries. The factors affecting the incidence and predictors of acute decompensations among cirrhosis patients are not well studied and known. Therefore, this study aimed to determine the incidence and predictors of acute decompensation among adult cirrhotic patients at the University of Gondar Comprehensive Specialized Hospitals in northwest Ethiopia in 2025. An institution-based retrospective cohort study was conducted from January 1, 2020 to December 30,2024 at the University of Gondar Comprehensive Specialized Hospital among 403 participants. All adult patients aged ≥ 18 years who had cirrhosis during the study period were included. Data were collected using a structured, pre-tested checklist by reviewing patients’ charts. Descriptive statistics were used to summarize the characteristics of the study population. Bivariable and multivariable Cox proportional hazards models were used to identify the predictors of acute decompensation. 95% confidence intervals of hazard ratios and p-values < 0.05 in the multivariable Cox proportional hazards model were used to identify the significant predictor variables. The Schoenfeld residuals test was used to assess the fitness of the Cox proportional hazards model. A total of 403 adult patients with cirrhosis were followed for 965.71 person-years. At the end of the follow-up, 195/403 (48.3%) patients developed acute decompensations with an incidence rate of 20 acute decompensations per 100 person-years of observation (95% CI: 17–23). The overall median survival time was 3.73 years (95% CI for median survival: 3.50 − 4.24), and the median time to acute decompensation among acute decompensation patients was 1.53 years (IQR: 0.62–3.59). Upper gastrointestinal bleeding (59.9%) was the leading acute decompensation event, followed by Spontaneous bacterial peritonitis (37.9%), jaundice (7.7%), and Hepatic encephalopathy (6.2%). The Cox proportional hazard regression model was fitted to identify predictors of acute decompensations. From the multivariable analysis Hemoglobin < 7 g/dl (AHR = 2.44, 95% CI:1.64–3.63), hemoglobin of 7–11.5 g/dl (AHR = 1.72, 95% CI:1.14–2.62), Serum Glutamic-Oxaloacetic Transaminase > 100 IU/L (AHR = 1.77, 95% CI:1.10–2.85,) and International Normalized Ratio > 2 (AHR = 1.55, 97% CI:1.01–2.37). and log-transformed creatinine (AHR = 1.50, 95% CI:1.12–2.01) were significant predictors of the incidence of acute decompensation. In this study, the incidence of acute decompensations in patients with cirrhosis is high and occurred early. Decreased Hemoglobin, high Serum Glutamic-Oxaloacetic Transaminase, International Normalized Ratio, and creatinine were significantly associated with increased risk of acute decompensation. Therefore, following these parameters and correcting these abnormal finding in patients with cirrhosis will decrease the incidence rate.