Acute-on-chronic liver failure: an update

• Published in: Gut Vol. 66; no. 3; pp. 541 - 553
• Main Authors: Hernaez, Ruben, Solà, Elsa, Moreau, Richard, Ginès, Pere
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.03.2017; BMJ Publishing Group
• Subjects: Acute-On-Chronic Liver Failure - diagnosis; Acute-On-Chronic Liver Failure - etiology; Acute-On-Chronic Liver Failure - prevention & control; Acute-On-Chronic Liver Failure - therapy; Alcoholism; Artificial organs; Bacterial infections; Colony-stimulating factor; Consortia; Drug abuse; Failure; Gastroenterology; Hemodialysis; Hepatitis; Hepatitis, Alcoholic - complications; Hepatitis, Viral, Human - complications; Hepatology; HIV; Human immunodeficiency virus; Humans; Hypertension; Infections; Inflammation; Inflammation - complications; Intensive care; Leukocytes (granulocytic); Liver cirrhosis; Liver diseases; Liver failure; Liver Transplantation; Medical prognosis; Mortality; Prognosis; Recent Advances in Clinical Practice; Sepsis; Sepsis - complications; Severity of Illness Index; Short term; Terminology as Topic; Transplants & implants; LIVER CIRRHOSIS; LIVER FAILURE
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2016-312670

Acute-on-chronic liver failure (ACLF) is a syndrome characterised by acute decompensation of chronic liver disease associated with organ failures and high short-term mortality. Alcohol and chronic viral hepatitis are the most common underlying liver diseases. Up to 40%–50% of the cases of ACLF have no identifiable trigger; in the remaining patients, sepsis, active alcoholism and relapse of chronic viral hepatitis are the most common reported precipitating factors. An excessive systemic inflammatory response seems to play a crucial role in the development of ACLF. Using a liver-adapted sequential organ assessment failure score, it is possible to triage and prognosticate the outcome of patients with ACLF. The course of ACLF is dynamic and changes over the course of hospital admission. Most of the patients will have a clear prognosis between day 3 and 7 of hospital admission and clinical decisions such as evaluation for liver transplant or discussion over goals of care could be tailored using clinical scores. Bioartificial liver support systems, granulocyte-colony stimulating factors or stem-cell transplant are in the horizon of medical care of this patient population; however, data are too premature to implement them as standard of care.