Abstract: Objective To analyze and identify the risk factors associated with recurrent decompensation in patients with HBV-related decompensated cirrhosis after treatment-induced re-compensation. Methods A retrospective study was conducted by telephone follow-up and review of medical records to select HBV-related patients with initial decompensated cirrhosis treated in the department of hepatology from January 2017 to January 2021. Patients whose liver function recovered to a recompensated state after comprehensive treatment, including antiviral therapy, were included as study subjects. Continuous follow-up was conducted for 12 months. Based on the occurrence of decompensation, patients were divided into a sustained compensation group and a re-decompensation group. The groups were compared for general information such as gender and age, biochemical indicators at the time of initial decompensation, the first decompensation event, organ damage, Child-Pugh score, and serum HBV-DNA negativity. Multivariate binary logistic regression analysis was performed, including indicators with statistical significance (P<0.2) from univariate binary logistic regression analysis, to explore risk factors for re-decompensation after re-compensation. Results This study initially included 412 patients, with 203 cases (49.27%) achieving re-compensation after treatment and follow-up. These 203 patients were continuously observed over 12 months and were categorized into two groups based on the presence of decompensation: sustained re-compensation (102 cases) and recurrent decompensation (101 cases). Comparative analysis between the groups revealed statistically significant differences in disease course, number of complications during initial decompensation, biochemical indicators including total bilirubin (TBil), cholinesterase (CHE), prealbumin (PA), creatinine (Cr), FBG (fast blood glucose), procalcitonin (PCT) during the initial decompensation, Child-Pugh scores (at initial decompensation, 6 months, and 12 months), and the HBV-DNA negative conversion rate at 6 months (P<0.05). Univariate binary logistic regression analysis identified variables with P<0.2, including disease course, multiple complications during initial decompensation, biochemical indicators (TBil, CHE, Cr) during initial decompensation, Child-Pugh scores (at initial decompensation, 6 months, and 12 months), and the HBV-DNA negative conversion rate (at 6 and 12 months), which were then included in a multivariate binary logistic regression analysis (stepwise regression). The results indicated that multiple complications during the initial decompensation event, biochemical indicators (CHE, Cr) during initial decompensation, the HBV-DNA negative conversion rate at 6 months, and the Child-Pugh score at 6 months were risk factors for recurrent decompensation after the first re-compensation in HBV-related decompensated cirrhosis (P<0.05). Specifically, high serum CHE levels during initial decompensation and the negative conversion of HBV-DNA at 6 months were protective factors against recurrent decompensation after re-compensation, while multiple complications during initial decompensation, high serum Cr levels, and a high Child-Pugh score at 6 months were risk factors for recurrent decompensation after re-compensation. Conclusion After comprehensive treatments including antiviral therapy, approximately 49.27% of patients can achieve re-compensation. The number of complications during the first decompensation event, biochemical indicators (CHE, Cr) at the initial decompensation, and HBV-DNA and Child-Pugh scores during follow-up monitoring can provide predictive references for the maintenance of re-compensation.

Key words: HBV-related decompensated cirrhosis, Recompensation, Maintenance, Influencing factors