Impact of Cirrhosis-Related Complication Burden on 30- and 60-Day Mortality Among Hospitalized Patients with Cirrhosis: A Prospective Cohort Study

Background and Objectives: Patients with decompensated cirrhosis often present with multiple concurrent complications, but the prognostic value of the cumulative complication burden remains unclear. This study evaluated the association between the number of concurrent cirrhosis-related complications and 30-day and 60-day mortality and assessed whether complication burden added prognostic information beyond MELD-Na. Materials and Methods: This prospective cohort study included 128 consecutive adults with decompensated cirrhosis admitted to Da Nang Hospital between January and September 2025. Six cirrhosis-related complications were ascertained during the first 48 h of hospitalization: ascites, jaundice, overt hepatic encephalopathy, acute variceal bleeding, spontaneous bacterial peritonitis, and hepatorenal syndrome. Complication burden was defined as the total number of concurrent complications. The primary outcomes were all-cause mortality within 30 and 60 days. Multivariable logistic regression assessed the independent association of complication count with mortality, and predictive performance was compared among MELD-Na, complication count, and their combined model. Results: The median complication count was 2 (interquartile range, 1–3), and 80 patients (62.5%) had at least two complications. Thirty-day and 60-day mortality occurred in 40 (31.3%) and 48 patients (37.5%), respectively. Mortality increased progressively with complication burden. Thirty-day mortality rose from 14.3% among patients with one complication to 23.9%, 54.5%, and 90.0% among those with two, three, and four complications, respectively. Corresponding 60-day mortality rates were 21.4%, 30.4%, 59.1%, and 100.0% (p for trend < 0.001 for both outcomes). Each additional complication was independently associated with increased 30-day mortality (adjusted odds ratio, 2.51; 95% confidence interval, 1.34–4.69) and 60-day mortality (adjusted odds ratio, 2.75; 95% confidence interval, 1.48–5.12). Adding complication count to MELD-Na yielded AUCs of 0.835 and 0.806 for 30-day and 60-day mortality, respectively, with only modest, non-significant improvements in discrimination. Conclusions: Cirrhosis complication burden was independently associated with short-term mortality and provided partly complementary prognostic information beyond MELD-Na, although its incremental predictive value was modest and requires external validation in larger, multicenter cohorts.