•Bacterial infections and/or severe alcoholic hepatitis are the major precipitants of acute decompensation and ACLF.•The type of precipitating event had no association with survival.•The number of identifiable events was significantly associated with surrogates of systemic inflammation and increased 90-day mortality.•Adequate first-line antibiotic treatment of proven bacterial infections reduced ACLF development and improved 90-day survival.•Strategies to prevent or treat precipitating events may improve outcome in decompensated cirrhosis.
