Acute-on-Chronic liver failure – A brief overview

Abstract

Acute-on-chronic liver failure (ACLF) is a clinical syndrome defined by an acute insult (intrahepatic or extrahepatic) on a diseased liver (which may be diagnosed or undiagnosed). What follows next is activation of various immune and inflammatory pathways that may ultimately result in cytokine storm, immune exhaustion, and finally immune paralysis. The patients may succumb to secondary infections and multi-organ failure. In contrast, timely therapeutic measures may reverse the systemic inflammation and improve overall prognosis. Although the syndrome has been defined differently by various liver societies across the world, all these definitions address a sudden deterioration of clinical condition, poor short-term survival, and possible reversibility with timely intervention. This review addresses various definitions, pathophysiology, and management of patients with ACLF. Role of liver transplantation and various novel therapies have also been briefly described. Finally, scope for future research in patients with ACLF has also been outlined.