Acute-on chronic liver failure

Abstract

Acute-on-chronic liver failure (ACLF) is an increasingly recognised entity encompassing an acute deterioration of liver function in patients with cirrhosis, which is usually associated with a precipitating event and results in the failure of one or more organs and high short term mortality. Prospective data to define this is lacking but there is a large body of circumstantial evidence suggesting that this condition is a distinct clinical entity. From the pathophysiologic perspective, altered host response to injury and infection play important roles in its development. This review focuses upon the current understanding of this syndrome from the clinical, prognostic and pathophysiologic perspectives and indicates potential biomarkers and therapeutic targets for intervention.

Hepatitis E and Acute-on-Chronic Liver Failure

“…6 Although, there is no universally agreed definition of this entity, two consensus working definitions for this syndrome exist: one put forward by the Asia-Pacific Association for the Study of Liver (APASL) 7 and the other based on an EASL-AASLD single topic symposium. 8 According to the APASL, ACLF is defined as 'Acute hepatic insult manifesting as jaundice and coagulopathy, complicated within 4 weeks by ascites and/or encephalopathy in a patient with previously diagnosed or undiagnosed chronic liver disease'.…”

“…In a proportion of patients, there may be no identifiable precipitating event. 6 Superimposed viral infections with hepatotropic viruses in patients with cirrhosis can have devastating consequences by direct hepatocellular damage. Perhaps, the best examples are HEVsuperinfection 15 and reactivation of hepatitis B virus (HBV) in patients on immunosuppression.…”

Clinical Classification of Liver Failure: Consensus, Contradictions and New Recommendations

“…Guidelines and consensus for types of LF come mainly from Europe and the United States: they include the criteria for ALF recommended by the American association for Study of Liver Diseases (AASLD), in 2005 [2]; ACLF consensus released by the Asia-Pacific Association for the study of Liver (APASL), in 2009 [16]; and the consensus on ACLF by AASLD and the European association for the Study of Liver (EASL), in 2011 [4].…”

“…Most scholars in Europe and the United States believe that the basic underlying disease is compensated cirrhosis [4,29]. Moreau et al [24] have stated that decompensated cirrhosis is the basis of ACLF.…”

“…In recent years, international organizations or societies have issued several guidelines or consensuses about the diagnosis and classification of LF [3][4][5]. In China, Guidelines for Liver Failure Diagnosis and Treatment were released in 2006 and updated in 2012 by the Liver Failure and Artificial Liver Group of the Chinese association of Infectious Diseases, and the Severe Liver Disease and Artificial Liver Group of the Chinese association of Hepatology [6,7].…”