Etiology-related differences in hepatic recompensation in decompensated cirrhosis under Baveno VII criteria: a systematic review and meta-analysis.

backgroundDecompensated cirrhosis has different causes. These causes differ in how they damage the liver, how difficult they are to treat, and how well they can be controlled. This may lead to different prevalences of recompensation. However, existing studies have failed to elucidate the heterogeneity of recompensation across different etiologies. Therefore, this study aimed to summarize differences in recompensation prevalence among decompensated cirrhosis etiologies according to the Baveno VII consensus, and to analyze the predictors and prognosis of recompensation.

methodsWe screened four databases up to February 2, 2026, and included only cohort studies (prospective or retrospective) in English or Chinese. Quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool for prevalence studies. A random‑effects model was used when I² > 50% and p < 0.05; otherwise, a fixed‑effects model was applied. We calculated pooled recompensation prevalence with 95% confidence intervals (CIs) for each etiology, evaluated predictors of recompensation, and assessed prognostic outcomes. Publication bias was assessed using Begg's and Egger's tests, and sensitivity analyses tested the robustness of the findings.

resultsThe total recompensation prevalence of decompensated cirrhosis was reported from 22 studies (n = 7585), with an overall recompensation prevalence of 34% (95%CI = 27%-41%), of which 38% (95%CI = 31%-45%) in the eastern region and 24% (95%CI = 9%-39%) in the western region. Hepatitis B virus (HBV)-related decompensated cirrhosis had the highest prevalence (49%, 95% CI = 33%-65%), followed by those with decompensated cirrhosis caused by hepatitis C virus (HCV), autoimmune liver disease (AILD), and alcoholic liver disease (ALD), with corresponding recompensation prevalence of 38% (95%CI = 23%-53%), 27% (95%CI = 24%-30%), 19% (95%CI = 3%-35%), respectively. Through pooled effect estimates, independent predictors of recompensation included gender, platelet count, albumin (ALB), Model for End-Stage Liver Disease (MELD) score, Child-Turcotte-Pugh (CTP) score, and Alanine Transaminase (ALT). For example, women and patients with higher ALB levels or lower MELD/CTP scores were more likely to achieve recompensation. Recompensation significantly improved the prognosis of patients with decompensated cirrhosis [hazard ratio (HR) = 2.81, 95%CI = 1.78-4.42, p<0.001].

conclusionThe prevalence of recompensation was highest in HBV-related decompensated cirrhosis, followed by HCV, then AILD, and lowest in ALD-related decompensated cirrhosis. Gender, platelet count, ALB, MELD score, CTP score, and ALT were independent predictors of recompensation. After achieving recompensation, the prognosis of patients with cirrhosis improved significantly. These findings suggest that etiology-specific recompensation prevalences may help guide individualized monitoring and treatment strategies in patients with advanced cirrhosis.

trial registrationCRD420261298240.