This project aims to investigate cardiac function in patients with cirrhosis in the acute setting. Acute decompensation and acute-on-chronic liver failure are major events in the life of a patient as they herald disease progression and negative prognosis. Cardiocirculatory function will be assessed by serial assessments in patients admitted for acute decompensation of cirrhosis.

In this project we aim to investigate the dynamic role of cardiac function in the short-term evolution of patients with AD of cirrhosis through noninvasive and accessible tests and validate prognostic imaging and serum biomarkers. The main objectives are:

1. To describe changes and evolution of cardiac function in AD of cirrhosis
2. To investigate associations between echocardiographic parameters and serum biomarkers
3. To investigate the association between ACLF and cardiac dysfunction
4. To assess the short-term prognostic impact of cardiac function in AD and ACLF;
5. To evaluate the added predictive value of cardiac markers to current scores (CLIF-C).

Inclusion Criteria:

• proven cirrhosis with acute decompensation

Exclusion Criteria:

• screening after > 72 hours from admission
• previous severe cardiac conditions (e.g. ischemic heart disease, atrial fibrillation, congestive heart failure, ICD)
• concomitant severe disease (e.g. active neoplasia, severe COPD, etc)
• lack of informed consent
• intubated/ comatose patient

All cirrhotic patients admitted for acute decompensated cirrhosis will be screened, regardless of gender, etiology of liver disease, and age (if above 18 years).