Objective To investigate the influencing factors for recompensation in patients with first-time decompensated hepatitis B cirrhosis. Methods A total of 438 patients with first-time decompensated hepatitis B cirrhosis who attended The Affiliated Hospital of Xuzhou Medical University from September 1, 2011 to December 31, 2019 were enrolled, and all patients received comprehensive treatment including antiviral therapy. According to the outcome at the end of follow-up, the patients were divided into recompensation group and persistent decompensation group, and the independent influencing factors for recompensation were analyzed. Long-term survival rate was compared between the patients with different states of compensation. The Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data. A multivariate Cox proportional-hazards regression model analysis was used to investigate the influencing factors for recompensation. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison. Results Among the 438 patients with decompensated hepatitis B cirrhosis, 199 (45.4%) achieved recompensation after antiviral therapy. There were significant differences between the recompensation group and the persistent decompensation group in sustained virologic response (SVR) ( χ 2 =72.093, P < 0.001), single or multiple complications ( χ 2 =9.834, P =0.002), presence or absence of gastrointestinal bleeding ( χ 2 =6.346, P =0.012), serum creatinine (SCr) ( Z =-1.035, P =0.011), blood sodium concentration ( Z =-1.606, P =0.019), hemoglobin ( Z =1.455, P =0.006), and alanine aminotransferase (ALT) level ( Z =-2.194, P < 0.001). Baseline ALT level (odds ratio [ OR ]=1.002, 95% confidence interval [ CI ]: 1.000-1.003, P =0.009), SVR ( OR =5.760, 95% CI : 3.634-9.129, P < 0.001), and SCr ( OR =0.990, 95% CI : 0.981-1.000, P =0.047) were independent influencing factors for recompensation. The recompensation group had a significantly higher 5-year survival rate than the persistent decompensation group (87.9% vs 72.0%, χ 2 =9.886, P =0.025). Conclusion After comprehensive treatment, including antiviral therapy, approximately 45.4% of patients can achieve recompensation.Patients with elevated baseline ALT and achieved SVR were more likely to achieve recompensation, patients with elevated baseline serum creatinine had difficulty achieving recompensation, and patients with recompensation had a better long-term prognosis than patients with persistent decompensation.