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Collagen type III desposition has been shown in acute decompensation. Extratracellular matrix is compiled of deposition of various components. The role of basement membrane collagen type IV in advanced cirrhosis and acute decompensation is unclear and investigated in this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with decompensated cirrhosis from the prospective NEPTUN cohort (ClinicalTrials.gov Identifier: NCT03628807), who underwent transjugular intrahepatic portosystemic shunt procedure were included. Clinical and laboratory parameters, PRO\u2010C4 and C4M levels were measured in blood samples from portal and hepatic veins just before transjugular intrahepatic portosystemic shunt placement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Levels of C4M and PRO\u2010C4 are significantly lower in patients with massive ascites and impaired renal sodium excretion. C4M and PRO\u2010C4 show gender\u2010specific profiles with significantly lower levels in females compared to males. Females with higher C4M levels show higher mortality. By contrast, males with higher C4M levels show lower mortality. In multivariate Cox regression analysis, C4M is an independent predictor of survival in female patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study shows that markers of collagen type IV remodelling do not accumulate in severe renal dysfunction. Although collagen type IV degradation markers derive from the liver, portal venous C4M levels are relevant for survival. Moreover, it demonstrates that circulating C4M shows gender\u2010specific profiles, which can independently predict survival in female patients with decompensated cirrhosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14070","type":"journal-article","created":{"date-parts":[[2019,2,10]],"date-time":"2019-02-10T05:19:47Z","timestamp":1549775987000},"page":"885-893","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Collagen type IV remodelling gender\u2010specifically predicts mortality in decompensated cirrhosis"],"prefix":"10.1111","volume":"39","author":[{"given":"Jennifer","family":"Lehmann","sequence":"first","affiliation":[{"name":"Department of Medicine I University of Bonn Bonn 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