CirrhoCare- Using Smart-phone Technology to Enhance Care and Access to Treatment for Cirrhosis

Inclusion criteria:

1. Adults ≥ 18 years and diagnosed with cirrhosis of any aetiology.

2. Cirrhosis defined by standard clinical criteria, ultrasonographic findings and/orhistology. Cirrhosis of any aetiology may be included. However, participants withcirrhosis due to autoimmune hepatitis must be on a stable corticosteroid dose for ≥3-month period before study inclusion (to be recorded on concomitant log).

3. Cirrhosis severity-risk defined by European-Foundation Consortium Liver Failure -Acute Decompensation score (CLIF-C AD score) ≥42 points but ≤65 points at the timeof screening.

4. Hospitalisation for acute decompensation [determined as one or more of thefollowing: increasing ascites, variceal haemorrhage, overt hepatic encephalopathy,spontaneous bacterial peritonitis (SBP) or hepatorenal syndrome - acute kidneyinjury (HRS-AKI)].

5. Participants able to give informed consent.

Exclusion criteria:

1. Participants with ACLF grade 2 and above according to the criteria published byMoreau

2. Participants with CLIF-C AD score ≥ 66, who have a high mortality similar to ACLF ≥2participants.

3. Current overt hepatic encephalopathy, defined as grade II-IV hepatic encephalopathyaccording to the West-Haven classification, unable to give consent.

4. Participants with active hepatocellular carcinoma (HCC) or history of HCC that is inremission for less than six months for uninodular HCC or for less than 12 months formultinodular HCC within Milan criteria.

5. Participants with a history of significant extra hepatic disease with impairedshort-term prognosis, including congestive heart failure New York Heart AssociationGrade III/IV, COPD GOLD >2, chronic kidney disease with serum creatinine >2mg/dL orunder renal replacement therapy.

6. Participants with documented refractory ascites

7. Participants who are active on the transplant waiting list.

8. Participants with current extra hepatic malignancies including solid tumours andhematologic disorders.

9. Participants with mental incapacity, significant language barriers, or any otherreason considered by the investigator precluding adequate understanding, cooperationor compliance in the study.

10. Participants with active viral infections, or yet to achieve clear response toanti-viral therapy.

11. Any disorders likely to impact on study engagement, including severe frailty, severeaddiction history (including opioids) with evidence of multiple recent relapses.

12. Any other reason that the PI considers would make the participant unsuitable toenter CirrhoCare (e.g., participants on an end-of-life palliative care pathway).

13. Participants enrolled in other interventional trials.