Profiling circulating microRNAs in patients with cirrhosis and acute-on-chronic liver failure

•Circulating miRNAs are dysregulated with cirrhosis progression and in patients with ACLF.•Patient decompensation is associated with important changes in the levels of circulating miRNAs.•A total of 11 circulating miRNAs were identified as associated with organ failure and 7 with poor outcome.•The miRNAs most dysregulated during cirrhosis progression were miR-146a, miR-26a, and miR-191.•miR-146a was dysregulated in PBMCs of patients with decompensated cirrhosis vs. compensated cirrhosis.