Retrospective cohort study of 1,213 U.S. Veterans with HCV-related decompensated cirrhosis (imaging-confirmed ascites) who achieved SVR after DAA therapy; evaluated frequency, predictors, and survival impact of recompensation (Baveno VII criteria) over up to 24 months post-DAA initiation.
13% of patients (163/1,213) achieved recompensation within 24 months of DAA initiation. Higher baseline albumin predicted recompensation; platelet count <110 ×10⁹/L and further decompensation reduced its likelihood. Recompensation was associated with lower subsequent all-cause mortality.
Retrospective design limits causal inference; cohort is exclusively U.S. male Veterans, reducing generalizability to women and non-Veteran populations; recompensation ascertainment relied on documented ascites resolution, which may miss or misclassify cases.
After HCV cure, roughly 1 in 8 patients with decompensated cirrhosis can recompensate — prioritize SVR in patients with preserved albumin and less severe portal hypertension (platelets ≥110 ×10⁹/L), as they are most likely to benefit. Ascites resolution alone captures most Baveno VII recompensation and can serve as a practical bedside marker to track disease reversal.
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