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Decompensated chronic liver disease is the 14th leading cause of mortality in adults. It includes many aetiologies, some of which are treatable and preventable, whereas others are not. It is a progressive disease, resulting in various manifestations such as portal hypertension, hepatorenal syndrome, portopulmonary hypertension, ascites, spontaneous bacterial peritonitis (SBP), variceal bleeding and cardiomyopathy, which unless treated, result in end-stage liver failure requiring liver transplantation as treatment. In the present article, we review its aetiopathogenesis, clinical features and the current guidelines recommended for its treatment from a high volume tertiary care centre in India.