The 4th GA meeting of DECISION took place from 19-21 October 2022 in Madrid. The meeting was a great success with the first day devoted to paper writing: on that day, 12 meetings took place to discuss and progress on 7 different papers with more than 20 people. On the second day, we extensively discussed the specifics of our upcoming COMBAT-Trial as well as our brand new and refined animal models of ACLF. The third day was devoted to multi-omics analyses, bioinformatics and machine learning as well as an update on the newly developed tools and checklists for ethics and data protection and the health economics studies planned in DECISION. We thank our Scientific Advisory Board members for their valuable feedback to improve the quality of our studies.