In the traditional view, the occurrence of cirrhosis‐related complications, such as hepatic encephalopathy, formation of ascites or variceal haemorrhage, marks the transition to the decompensated stage of cirrhosis. Although the dichotomous stratification into a compensated and decompensated state reflects a prognostic water‐shed moment and remains to hold its prognostic validity, it represents an oversimplification of clinical realities. A broadening understanding of pathophysiological mechanisms underpinning decompensation have led to the identification of distinct prognostic subgroups, associated with different clinical courses following decompensation. Data provided by the PREDICT study uncovered three distinct sub‐phenotypes of acute decompensation (AD). Moreover, acute‐on‐chronic liver failure (ACLF) has been established as a distinct clinical entity for many years, which is associated with a high short‐term mortality. Recently, non‐acute decompensation (NAD) has been proposed as a distinct pathway of decompensation, complementing current concepts of the spectrum of decompensation. In contrast to AD, NAD is characterized by a slow and progressive development of complications, which are often presented at first decompensation and/or in patients in an earlier stage of chronic liver disease. Successful treatment of AD or NAD may lead to a clinical stabilization or even the concept of recompensation. This review aims to provide an overview on current concepts of decompensation and to delineate recent advances in our clinical and pathophysiological understanding.

中文翻译：

---

肝硬化的急性和非急性失代偿 (47/130)

传统观点认为，肝硬化相关并发症的发生，如肝性脑病、腹水或静脉曲张出血等，标志着肝硬化向失代偿期的过渡。尽管代偿状态和失代偿状态的二分分层反映了预后的分水岭，并且仍然保持其预后有效性，但它代表了对临床现实的过度简化。对失代偿病理生理机制的广泛理解导致了不同预后亚组的识别，这些亚组与失代偿后不同的临床过程相关。PREDICT 研究提供的数据揭示了急性失代偿 (AD) 的三种不同亚表型。此外，慢性肝衰竭急性发作（ACLF）多年来已被确立为一个独特的临床实体，与高短期死亡率相关。最近，非急性失代偿（NAD）被认为是一种独特的失代偿途径，补充了当前失代偿范围的概念。与 AD 相比，NAD 的特点是并发症缓慢且进行性发展，这些并发症通常在首次失代偿时出现和/或出现在慢性肝病早期阶段的患者中。AD 或 NAD 的成功治疗可能会导致临床稳定甚至再补偿的概念。本综述旨在概述当前失代偿的概念，并描述我们在临床和病理生理学理解方面的最新进展。