This multicentre, prospective, observational PREDICT study analyses and characterized the precipitants leading to AD. The PREDICT study included 1,273 patients with AD and focused on the characteristics of precipitants, specifically induction of organ dysfunction/failure and/or systemic inflammation, chronology, intensity, and relationship to outcome in both AD phenotypes (No-ACLF and ACLF). In particular, in proven bacterial infections and severe alcoholic hepatitis, either alone or in combination, accounted for almost all (96-97%) acute decompensation and ACLF. Whilst type of the precipitants was not associated with mortality, the number was. This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD. Specific preventative and therapeutic strategies targeting these events may improve outcome in decompensated cirrhosis.