Acute-on-Chronic Liver Failure

Abstract

Over the last two decades, the concept of acute-on-chronic liver failure (ACLF) has been proposed as an alternate path in the natural history of decompensated cirrhosis. ACLF is thus characterized by the presence of a precipitating event (identified or unidentified) in subjects with underlying chronic liver disease leading to rapid progression of liver injury and ending in multi-organ dysfunction characterized by high short term mortality. Multiple organ failure and increased risk for mortality are key to diagnosis of ACLF. The prevalence of ACLF ranges from 24–40% in hospitalized patients. The pathophysiological basis of ACLF can be explained using a 4 part model of predisposing event, injury due to precipitating event, response to injury and organ failure. Though several mathematical scores have been proposed for identifying outcomes with ACLF, it is yet unclear whether these organ failure scores are truly prognostic or are only reflective of the dying process. Treatment paradigms continue to evolve but consist of early recognition, supportive intensive care, and consideration of liver transplantation prior to onset of irreversible multiple organ failure.

Gut-Liver Axis Links Portal Hypertension to Acute-on-Chronic Liver Failure

“…Increased abdominal pressure due to ascites or atelectasis of the lung, due to hydrothorax, can facilitate the development of infections such as spontaneous bacterial peritonitis (SBP) or pneumonia, which, together with the increased risk of aspiration in the presence of hepatic encephalopathy (HE), might exacerbate to ACLF with a very poor prognosis [18][19][20][21]. However, the hemodynamic derangements in PHT might also predispose to ACLF.…”

Acute‐on‐Chronic Liver Failure: Getting Ready for Prime Time?

“…Acute on chronic liver failure (ACLF) is associated with rapid deterioration of liver function, leading to liver failure, multiple extrahepatic organ failures, and high short‐term mortality . Even if patients survive the acute insult, they may never return to their pre‐episode functional state . The term "acute decompensation" has been used to characterize ascites, gastrointestinal bleeding, HE, or infections without organ failure .…”

Plasma Apolipoprotein A-V Predicts Long-term Survival in Chronic Hepatitis B Patients with Acute-on-Chronic Liver Failure

“…Acute-on-chronic liver failure (ACLF) is an acute and rapid deterioration of previously well-compensated chronic liver disease12. In China and most other Asian countries, hepatitis B virus (HBV)-associated ACLF (HBV-ACLF) patients account for more than 50% of ACLF patients, owing to a high prevalence of chronic HBV infection3.…”