A retrospective cohort study evaluated the predictors and prognostic impact of sarcopenic obesity (Sa-O) on all-cause mortality in patients with cirrhosis. Sa-O was defined by computed tomography at the L3 level as a skeletal muscle index <42 cm²/m² in men or <38 cm²/m² in women together with a visceral adipose tissue area >100 cm². Multivariable analysis identified age (OR 1.813, 95% CI 1.210–2.718, p=0.0040), BMI ≥28 kg/m² (OR 0.076, 95% CI 0.018–0.310), alcoholic liver disease (OR 1.685, 95% CI 1.078–2.634, p=0.0220) and hypertension (OR 1.801, 95% CI 1.184–2.739, p=0.0059) as independent predictors of Sa-O. Based on these factors, the age–body mass index (BMI)–alcohol–hypertension (ABAH) score was developed. When stratified by ABAH score, groups with low (<100), intermediate (100–129), and high (≥130) scores had Sa-O rates of 8.4%, 18.7%, and 30.5%, respectively (p=0.026). The Cox model showed that patients with an intermediate score had a 1.53-fold higher risk of mortality (95% CI 1.12–2.09, p=0.007) and with a high score a 1.72-fold higher risk (95% CI 1.22–2.42, p=0.02) compared to the reference group. The ABAH score predicts the likelihood of Sa-O and is associated with all-cause mortality in cirrhotic patients.