{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T05:48:42Z","timestamp":1775886522687,"version":"3.50.1"},"reference-count":87,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Advanced chronic liver disease (ACLD) remains a major cause of global morbidity and mortality. Preventing hepatic decompensation\u2014both the first event and subsequent recurrences\u2014has become a central therapeutic goal to prolong survival. The transition from the compensated phase (cACLD) to the decompensated phase (dACLD) is driven by clinically significant portal hypertension (CSPH) and continuous exposure to etiologic factors, and is often precipitated by systemic triggers such as infections, portal vein thrombosis, and hepatocellular carcinoma. Thus, effective prevention requires a multidisciplinary strategy combining etiologic control with hemodynamic modulation, supported by vaccination, optimized nutrition and physical activity, judicious endoscopic therapy, and a critical reassessment of antibiotic prophylaxis in the era of antimicrobial resistance. Among non\u2010selective beta\u2010blockers (NSBBs), carvedilol\u2014through combined \u03b21\/\u03b22 and \u03b11 blockade\u2014achieves a greater reduction in hepatic venous pressure gradient (HVPG) than propranolol and demonstrates superiority in preventing first decompensation. In dACLD, although the effect of NSBBs is attenuated, carvedilol still emerges as the preferred option, given that propranolol shows significantly lower efficacy at this stage. Endoscopic variceal ligation (EVL) remains an alternative for NSBB\u2010intolerant patients in cACLD and is essential for secondary prophylaxis. Moreover, in dACLD, the combination of EVL with carvedilol is increasingly being explored in Child\u2010Pugh B\/C patients. We provide an overview of pathophysiological mechanisms, risk stratification using non\u2010invasive tests, and pragmatic prevention strategies across the different stages of disease, emphasizing recompensation, the NSBB \u201ctherapeutic window,\u201d and the need to revisit routine antibiotic prophylaxis.<\/jats:p>","DOI":"10.1111\/liv.70568","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T03:16:29Z","timestamp":1773026189000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preventing First and Further Decompensation in Advanced Chronic Liver Disease"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7210-6713","authenticated-orcid":false,"given":"Leonardo Corr\u00eaa","family":"S\u00fcffert","sequence":"first","affiliation":[{"name":"School of Medicine Pontif\u00edcia Universidade Cat\u00f3lica Do Rio Grande Do Sul  Porto Alegre 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