{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T21:20:46Z","timestamp":1788211246863,"version":"build-2803163510"},"reference-count":29,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T00:00:00Z","timestamp":1780704000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Decompensated cirrhosis is associated with high in-hospital mortality, influenced by disease severity and underlying etiology. The COVID-19 pandemic may have altered both the etiological spectrum and clinical presentation of hospitalized patients. This study aimed to assess longitudinal changes in etiology and identify predictors of in-hospital mortality over a 10-year period. Methods: We conducted a retrospective cohort study including 812 patients hospitalized with decompensated liver cirrhosis between 2015 and 2025. Patients were grouped into pre-COVID-19 (2015\u20132019), COVID-19 (2020\u20132021) and post-COVID-19 (2022\u20132025) periods. Etiological factors and mortality rates were compared using chi-square tests. Independent predictors were identified through multivariate analysis. A clinical risk score based on Child\u2013Pugh stage, platelet count and age was developed and evaluated using ROC analysis. Results: Alcohol-related cirrhosis increased significantly from 51.2% (pre-COVID-19) to 90.4% (COVID-19) and remained high post-COVID-19 (86.3%) (p &lt; 0.001), while HCV decreased from 34.4% to 13.5% and stabilized at 14.8% (p &lt; 0.001). HBV showed no significant variation. All-cause in-hospital mortality increased from 19.7% pre-COVID-19 to 42.3% during COVID-19 and remained elevated post-COVID-19 at 34.5% (p &lt; 0.001). Independent predictors of all-cause in-hospital mortality included advanced Child\u2013Pugh stage, thrombocytopenia and age above 70 years. The risk score (0\u20137 points) showed good discrimination (AUC = 0.752), with mortality rates of 2.8%, 24.0% and 45.7% across increasing risk categories. A score &lt;5 had a negative predictive value of 84.3%. Conclusions: A significant etiological shift from HCV to alcohol was observed, accompanied by persistently increased mortality after COVID-19. Thrombocytopenia remains an important predictor of mortality. The proposed score enables simple and effective risk stratification.<\/jats:p>","DOI":"10.3390\/diseases14060203","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T02:32:46Z","timestamp":1780885966000},"page":"203","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Changing Etiological Patterns and Predictors of In-Hospital Mortality in Decompensated Cirrhosis: A 10-Year Cohort Study Before and After COVID-19"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0441-3905","authenticated-orcid":false,"given":"Lavinia Alice","family":"B\u0103l\u0103ceanu","sequence":"first","affiliation":[{"name":"Clinical Department 1\u2014Medical Semiology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Internal Medicine Department, Clinical and Emergency Hospital \u201cSf. Ioan\u201d, 042122 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Georgeta","family":"Iacobescu","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Clinical and Emergency Hospital \u201cSf. Ioan\u201d, 042122 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana Valeria","family":"Grigorescu","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Clinical and Emergency Hospital \u201cSf. Ioan\u201d, 042122 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ion Daniel","family":"Baboi","sequence":"additional","affiliation":[{"name":"Clinical Department 1\u2014Medical Semiology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Gastroenterology Department, Clinical and Emergency Hospital \u201cSf. Ioan\u201d, 042122 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4583-2855","authenticated-orcid":false,"given":"Marian-Vlad","family":"Lapadat","sequence":"additional","affiliation":[{"name":"Clinical Department 1\u2014Medical Semiology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Gastroenterology Department, Clinical and Emergency Hospital \u201cSf. Ioan\u201d, 042122 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6704-4890","authenticated-orcid":false,"given":"Ion","family":"Dina","sequence":"additional","affiliation":[{"name":"Clinical Department 1\u2014Medical Semiology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Gastroenterology Department, Clinical and Emergency Hospital \u201cSf. Ioan\u201d, 042122 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,6]]},"reference":[{"key":"ref_1","first-page":"516","article-title":"Global burden of liver disease: 2023 update","volume":"43","author":"Devarbhavi","year":"2023","journal-title":"Semin. Liver Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.jhep.2021.05.022","article-title":"Burden of non-alcoholic fatty liver disease in Asia, the Middle East and North Africa: Data from Global Burden of Disease 2009\u20132019","volume":"75","author":"Golabi","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Battle, A., Mudd, J., Ahlenstiel, G., and Kalo, E. (2025). Liver Cirrhosis: Evolving Definitions, and Recent Advances in Diagnosis, Prevention and Management. 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Hepatol."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/6\/203\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T03:21:02Z","timestamp":1780888862000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/6\/203"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,6]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["diseases14060203"],"URL":"https:\/\/doi.org\/10.3390\/diseases14060203","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,6]]}}}