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Shifting cirrhosis phenotype with changes in liver disease etiology in an Australian tertiary hospital
Ryma Terbah, Chris Zhao, Tessa Greeve, Elise Cannan, Darren Wong, Adam Testro, Avik Majumdar, Marie Sinclair
Ryma Terbah, Chris Zhao, Tessa Greeve, Elise Cannan, Darren Wong, Adam Testro, Avik Majumdar, Marie Sinclair, Department of Gastroenterology and Liver Transplantation, Austin Health, Melbourne 3084, Victoria, Australia
Ryma Terbah, Darren Wong, Adam Testro, Avik Majumdar, Marie Sinclair, Department of Medicine (Austin), The University of Melbourne, Melbourne 3010, Victoria, Australia
Ryma Terbah, Darren Wong, Adam Testro, Avik Majumdar, Marie Sinclair, The Australian Centre for Transplantation Excellence and Research, Austin Health, Melbourne 3084, Victoria, Australia
Adam Testro, Department of Surgery (Austin Precinct), The University of Melbourne, Melbourne 3010, Victoria, Australia
Author contributions: Terbah R, Testro A, Majumdar A, and Sinclair M conceived and designed the study; Terbah R, Zhao C, Greeve T, and Cannan E performed the data collection; Wong D performed the statistical data analysis; Terbah R, Testro A, Majumdar A, and Sinclair M interpreted the data; Terbah R and Sinclair M drafted the manuscript. All authors edited and critically reviewed the manuscript and approved the final version of the manuscript.
Institutional review board statement: Ethical approval for the study was granted by the Austin Health Research Ethics Committee (approval No. Audit/20/Austin/129) and the study was conducted in accordance with the Declaration of Helsinki and the Declaration of Istanbul.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data that support the findings of this study may be made available from the corresponding author upon reasonable request.
Corresponding author: Marie Sinclair, PhD, Associate Professor, FRACP, Department of Gastroenterology and Liver Transplantation, Austin Health, 145 Studley Road, Heidelberg, Melbourne 3084, Victoria, Australia.
marie.sinclair@austin.org.au
Received: October 13, 2025
Revised: November 20, 2025
Accepted: February 2, 2026
Published online: April 27, 2026
Processing time: 196 Days and 21.9 Hours
BACKGROUND
The introduction of effective direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) has changed the landscape of chronic liver disease worldwide.
AIM
To compare the trends in etiologies of liver disease and causes of liver-related hospital admissions at a single tertiary transplant centre in Australia in the eras before and after DAA therapy.
METHODS
A single-centre observational study was conducted to identify patients admitted to hospital with decompensated cirrhosis in the 2012 (pre-DAA) and 2019 (post-DAA) calendar years. The primary outcome was the reason for admission. Secondary outcomes included etiology of liver disease and cause of hospitalisation by etiology.
RESULTS
One hundred and seventy-eight patients with cirrhosis were admitted in 2012 compared to 198 patients in 2019. There was no significant difference in the gender, age or model for end-stage liver disease score (all P > 0.4) between the two cohorts. Ascites remains the most common complication, however the incidence rate decreased between eras, while the incidence rate of non-variceal bleeding increased. HCV-related cirrhosis admissions decreased, while non-alcoholic steatohepatitis-related cirrhosis admissions increased.
CONCLUSION
This study demonstrates a shift in the phenotype of cirrhosis, with increasing admissions for non-variceal bleeding and fewer admissions for ascites. This may be due to a shift in etiology of liver disease, with fewer cases of HCV-related and increasing non-alcoholic steatohepatitis-related cirrhosis. Further work is required to better understand cirrhosis presentations in the context of rising steatotic liver disease cases and to plan adequate resource allocation to allow health systems to cope with an increasingly complex patient population.
Core Tip: Effective treatment is now available for chronic hepatitis C, and as a result, hospitalisation of patients with hepatitis C-related cirrhosis is decreasing, while metabolic-associated steatotic liver disease is rapidly becoming one of the most common causes of cirrhosis requiring hospital admission to a major tertiary hospital in Australia. The phenotype of patients with cirrhosis is also shifting, with a decreasing incidence rate of ascites and hepatic encephalopathy and increasing incidence of non-variceal bleeding. Information on the shifting etiologies, phenotypes and prevalence of complications of cirrhosis is helpful for planning future resource allocation and devising novel ways of managing these patients.
