Abstract: Objective To investigate the impact of recompensation on liver disease-related mortality and the incidence of hepatocellular carcinoma (HCC) in patients with decompensated liver cirrhosis due to viral hepatitis. Methods A total of 734 patients diagnosed with decompensated liver cirrhosis due to chronic hepatitis B viral (HBV) and chronic hepatitis C viral (HCV) infection who were treated at the Third People′s Hospital of Kunming from January 1, 2016 to December 31, 2022 were collected. The patients′ data were reviewed and they were divided into a recompensation group (n=270) and a persistent decompensation group (n=464). The incidence of HCC and liver disease-related death from the time of enrollment to the end of the study was collected. Univariate logistic regression analysis was conducted to identify the factors that might affect the poor prognosis of patients with decompensated liver cirrhosis due to viral hepatitis. Variables with significant differences in the univariate comparison analysis were further screened by lasso regression to select a subset of variables without multicollinearity, which were then included in the multivariate logistic regression analysis. Survival curves were plotted using the Kaplan-Meier method and compared using the log-rank test. Results The mortality rate of patients in the persistent decompensation group was significantly higher than that in the recompensation group (13.60% vs. 8.10%, χ²=4.914, P=0.027)(63/464 vs. 22/270). The incidence of HCC in the recompensation group was significantly lower than that in the persistent decompensation group (8.10% vs. 17.70%, χ²=12.731, P<0.001)(22/270 vs. 82/464). Univariate logistic regression analysis showed that recompensation, etiology, history of drug abuse, history of TIPS surgery, age, PLT, TBil, DBil, TBA, Alb, PA, IL-6, PTA, APTT, CEA, CA125, PIVKA-II, TSH, IL-1β, IgG, blood ammonia, and complement C4 were the influencing factors of HCC risk and death risk in patients with decompensated viral hepatitis-related cirrhosis (P<0.05). Multivariate logistic regression analysis showed that recompensation (OR=0.572, 95% CI: 0.374~0.874, P=0.010), age (OR=1.025, 95% CI: 1.006~1.044, P=0.011), and PIVKA-II (OR=1.002, 95% CI: 1.000~1.004, P=0.017) were independent influencing factors for the occurrence of liver cancer and liver disease-related death in patients with decompensated viral hepatitis-related cirrhosis. Conclusion The occurrence of re-compensation can significantly reduce the incidence risk of HCC and the mortality rate in patients with decompensated liver cirrhosis caused by viral hepatitis.

Key words: Viral hepatitis, Liver cirrhosis, Recompensation, Hepatocellular carcinoma, Mortality rate, Poor prognosis