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We excluded patients with a history of hepatocellular carcinoma (HCC) or both prevalent ascites and hepatic encephalopathy. Fine-Gray sub-distribution hazard models were used to characterize time-to-incident hepatic decompensation and incident HCC through 2020, with liver transplantation and death as competing events, and multivariable Fine-Gray regression was used to identify associated factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 1029 patients (median age 58 years, 54.9% male, 19.5% non-Hispanic White). Over a median follow-up of 84.7 months, 36.4% developed incident hepatic decompensation (46.7% ascites, 21.1% hepatic encephalopathy, and 32.3% ascites plus hepatic encephalopathy), 14.5% developed HCC, 2.0% underwent transplant, and 23.0% died. The cumulative 1-, 2-, and 3-year incidence of hepatic decompensation were 7.0%, 10.8%, and 16.3% and incidence of HCC were 3.0%, 5.0%, and 6.9%, respectively. Compared to viremic hepatitis C, higher risk of hepatic decompensation was associated with metabolic dysfunction-associated steatotic liver disease (MASLD) (sHR 1.52, 95% CI 0.94 - 2.45) and alcohol-associated cirrhosis (sHR 1.68, 95%CI 1.10 - 2.57), while incident HCC was inversely associated with MASLD (sHR 0.27; 95% CI 0.12\u20130.59) and alcohol-associated cirrhosis (sHR 0.45; 95% CI 0.23\u20130.84).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Increasing proportions of non-viral liver disease will likely lead to a greater burden of hepatic decompensation and reduced HCC in contemporary populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-025-04538-y","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T06:08:57Z","timestamp":1765260537000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Etiology of cirrhosis is associated with risk of hepatic decompensation and hepatocellular carcinoma"],"prefix":"10.1186","volume":"26","author":[{"given":"Michelle","family":"Ng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olgert","family":"Bardhi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krystal","family":"Lai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eden","family":"Koo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sruthi","family":"Yekkaluri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Bass","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guruveer","family":"Bhamra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pojsakorn","family":"Danpanichkul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Quirk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ju Dong","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Louissaint","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas A.","family":"Kerr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit G.","family":"Singal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"4538_CR1","doi-asserted-by":"publisher","first-page":"2650","DOI":"10.1016\/j.cgh.2019.07.060","volume":"18","author":"AM Moon","year":"2020","unstructured":"Moon AM, Singal AG, Tapper EB. 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None of the authors have relevant conflicts of interest to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Amit Singal\n                      has served as a consultant or on advisory boards for Genentech, AztraZeneca, Eisai, Exelixis, Bayer, Merck, Elevar, Boston Scientific, Sirtex, FujiFilm Medical Sciences, Exact Sciences, Helio Genomics Roche, Glycotest, Abbott, IMCare, Curve Biosciences, DELFI, Universal Dx. None of the authors have relevant conflicts of interest to declare.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"22"}}