Temporal changes in etiology, complications, and infection-related admissions among patients with cirrhosis: a 20-year single-center study.

Background: The epidemiology and clinical presentation of cirrhosis have changed substantially over recent decades, driven by advances in antiviral therapy and shifts in the burden of chronic liver diseases. However, long-term real-world data describing concurrent changes in etiology, complications, and infection-related hospitalizations among patients with cirrhosis remain limited. This study was designed based on this background and these unmet clinical needs. By conducting a retrospective analysis of patients with liver cirrhosis hospitalized for the first time over more than 20 years at a tertiary medical center, this study aims to fill the gap in long-term real-world data in this field. Methods: In this retrospective observational study, adult patients hospitalized for cirrhosis for the first time between 2003 and 2025 at a tertiary medical center were included. Patients were grouped into five predefined periods according to the year of first hospitalization. Cirrhosis etiology, disease stage, and complications were systematically classified. Temporal changes in etiological composition and infection-related admissions were assessed descriptively, and trend analyses were performed where appropriate. Results: A total of 11,016 patients were analyzed. Viral-related cirrhosis remained the predominant etiology throughout the study period but declined significantly over time (93.12%-74.09%, Conclusion: Over the past two decades, the etiological and clinical landscape of cirrhosis has evolved substantially. The declining dominance of viral-related cirrhosis, rising contributions of autoimmune and metabolic etiologies, and a shifting infection spectrum underscore the need for adaptive, etiology- and infection-oriented management strategies in contemporary cirrhosis care.