Recent recommendations for the diagnosis and management of liver cirrhosis and its complications

INTRODUCTION: Progression of liver cirrhosis is a dynamic transition toward decompensation driven by portal hypertension (PH), while systemic inflammation (SI) mediates organ dysfunction and failure, acute-on-chronic liver failure (ACLF), and short-term mortality. The recent publication of the Baveno VIII consensus and of harmonized organ failure definitions calls for a reassessment of current concepts and recommendations. AREAS COVERED: PubMed/MEDLINE and Web of Science were searched from April 2026 to September 2026 for consensus documents, randomized trials, and large cohort studies on cirrhosis and its complications. Earlier landmark studies were included when they underpinned current recommendations, without any claim to completeness. Noninvasive risk stratification in compensated advanced chronic liver disease, prevention of first decompensation, the clinical phenotypes of decompensation, management of variceal bleeding including preemptive TIPS, ascites, hepatic encephalopathy, renal dysfunction, and ACLF are included together with practical guidance for triage and transfer to expert and transplant centers. EXPERT OPINION: Management is shifting from reactive treatment of individual complications toward mechanism-based, preemptive care guided by dynamic risk assessment. Harmonized ACLF definitions and biomarkers of systemic inflammation should now enable trials of disease-modifying therapy, the field's largest unmet need.