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Background/purpose: Patients with alcohol‐associated cirrhosis and acute decompensation are considered critically ill and have a higher risk of short‐term mortality. This study aimed to establish a nomogram to evaluate their 90‐day survival and identify factors that affect disease progression. Methods: We included patients from September 2008 to December 2016 (n = 387 in the derivation group) and from January 2017 to August 2020 (n = 157 in the validation group). LASSO regression and Cox multivariate risk regression were used to analyze the influencing factors of the 90‐day mortality risk, and a nomogram was constructed. The performance of a model was analyzed based on the C‐index, area under the receiver operating curve, calibration curve, and decision curve analysis. Results: Total bilirubin >10 upper limit of normal, high‐density lipoprotein cholesterol, lymphocyte and monocyte ratios ≤2.33, white blood cells, and hemoglobin were identified as independent risk factors affecting the 90‐day mortality risk of patients and the nomogram was developed. A nomogram demonstrated excellent model predictive accuracy in both the derivation and validation cohorts (C‐index: 0.976 and 0.945), which was better than other commonly used liver scoring models (p < 0.05). The nomogram also performed good calibration ability and more clinical net benefit. According to the nomogram score, patients were divided into high‐ and low‐risk groups. Mortality was significantly higher in the high‐risk group than in the low‐risk group (p < 0.0001). Conclusion: The nomogram could accurately predict the 90‐day mortality risk in patients with alcohol‐associated cirrhosis and acute decompensation, helping to identify high‐risk patients and personalize treatment at their first admission. [ABSTRACT FROM AUTHOR]