The PREDICT study, an observational study conducted in 44 European centers that looked at 1273 patients hospitalized with acute decompensation of cirrhosis in the critical period prior to acute-on-chronic liver failure (ACLF) development aimed to identify the precipitating events of ACLF and further understand the mechanisms of ACLF progression. Results from the PREDICT study have allowed to identify four patterns of acute decompensation of cirrhosis in hospitalized patients with cirrhosis (i.e., stable decompensated cirrhosis, unstable decompensated cirrhosis, pre-ACLF and ACLF) and further defining ACLF based on the number of organ/systems failures.