<b>The Patterns of Emergency Presentations in Patients With Chronic Liver Disease</b>

Background: Chronic liver disease (CLD) is a major cause of emergency department (ED) utilization due to acute decompensating events that carry high short-term morbidity and mortality. Local data describing ED presentation patterns in Pakistan remain limited, constraining protocol development and resource planning. Objective: To determine the patterns of emergency presentations, underlying etiologies, and immediate disposition outcomes among adults with CLD presenting to the ED of Lady Reading Hospital, Peshawar. Methods: This prospective cross-sectional observational study enrolled consecutive adults (≥18 years) with known or newly diagnosed CLD presenting with CLD-related emergency complications from 1 January 2025 to 30 June 2025. Data on demographics, CLD etiology, primary ED presentation, key clinical and laboratory abnormalities, and ED disposition were recorded using a structured proforma and analyzed using SPSS v26. Results: Among 120 patients (mean age 52.4 ± 11.6 years; 65% male), hepatitis C was the most common etiology (48.3%), followed by hepatitis B (18.3%). The leading primary presentations were upper gastrointestinal bleeding (26.7%), hepatic encephalopathy (23.3%), and tense ascites with respiratory compromise (16.7%); SBP/sepsis (11.7%) and AKI/HRS (8.3%) were also observed. Overall, 56.7% required ward admission, 23.3% ICU care, 15.0% were discharged after stabilization, and ED mortality was 5.0%. Conclusion: Upper gastrointestinal bleeding and hepatic encephalopathy were the predominant and most resource-intensive ED presentations in CLD, with hepatitis C as the leading etiology, underscoring the need for strengthened hepatitis control and standardized ED management pathways.