Abstract
Acute-on-chronic liver failure (ACLF) is a syndrome that develops in patients with acutely decompensated chronic liver disease. It is characterised by high 28-day mortality, the presence of one or more organ failures (OFs) and a variable but severe grade of systemic inflammation. Despite the peculiarity of each one, every definition proposed for ACLF recognizes it as a proper clinical entity. In this paper, we provide an overview of the diagnostic criteria proposed by the different scientific societies and the clinical characteristics of the syndrome. Established and experimental treatments are also described. Among the former, the most relevant are directed to support organ failures, treat precipitating factors and carry out early assessment for liver transplantation (LT). Further studies are needed to better clarify pathophysiology of the syndrome and discover new therapies.
Highlights
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Acute decompensation (AD) of cirrhosis refers to the development of ascites, gastrointestinal haemorrhage, hepatic encephalopathy or any combination of these, which leads to hospital admission [1]
The definition proposed by the European Association for the Study of the Liver— Chronic Liver Failure (EASL-CLIF) Consortium is based on the results of the CANONIC study, a multi-center prospective investigation in which 1343 patients non-electively hospitalized for AD of cirrhosis were enrolled, irrespective of prior episode(s) of AD [2]
Summary
Acute decompensation (AD) of cirrhosis refers to the development of ascites, gastrointestinal haemorrhage, hepatic encephalopathy or any combination of these, which leads to hospital admission [1]. The definition proposed by the European Association for the Study of the Liver— Chronic Liver Failure (EASL-CLIF) Consortium is based on the results of the CANONIC study, a multi-center prospective investigation in which 1343 patients non-electively hospitalized for AD of cirrhosis were enrolled, irrespective of prior episode(s) of AD [2]. Like the European one, the North American definition considers extra-hepatic OFs as part of the syndrome but does not include liver and coagulation It defines ACLF by the presence of two or more OFs among kidney, brain, circulation and respiration and stratifies patients according to the number of organ failures [5]. The severity of ACLF is assessed using a grading system based on the AARC score [9]
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