OBJECTIVES: To assess evidence-based quality metrics in patients with cirrhosis and its complications. METHODS: Adults with cirrhosis (ICD-9-CM 571.2 and 571.5) and complications post-diagnosis (ascites [789.59], HE [572.2] and SBP [567.23]) from 2009-2014 were identified from EMR data from an academic health system. Quality metrics for analysis were developed, including: (1) availability of MELD-Na, (2) diuretic therapy for ascites, (3) secondary prophylaxis for SBP, (4) appropriate treatment for HE, (5) SBP primary prophylaxis for qualifying patients, and (6) avoidance of non-recommended medications. Logistic regression was used to assess patient and physician-related factors that predicted achievement of parameters (2) and (4). Data analysis was conducted using SAS 9.4. RESULTS: A total of 4,116 patients with cirrhosis were identified: 986 (24.0%) with ascites, 665 (16.2%) with HE and 148 (3.6%) with SBP. A total of 67.54% of patients had a calculable MELD-Na. Receipt of therapy was 57.62% (diuretics) for ascites, 54.29% (secondary prophylaxis) and 60.61% (primary prophylaxis) for SBP and 49.83% for HE. A total of 68.16%, 71.45%, 72.38% of patients with ascites, HE and SBP respectively, were avoiding non-recommended medications. Regression for (2) demonstrated overweight patients (OR 0.665; 95% CI: 0.463-0.957) and non-specialists/non-primary care practitioners (OR 0.402; 95% CI: 0.208-0.775) were less likely to receive and provide quality care, respectively. Results for (4) showed that obese patients (OR 0.458; 95% CI: 0.289-0.725) were less likely to receive quality care. CONCLUSIONS: Quality of care was suboptimal and significant deviation in practice from evidence-based guidelines was observed.