Arroyo, V; Kamath, PS; Moreau, R; Jalan, R; Gines, P; Nevens, F; Fernandez, J; ... Schnabl, B; + view all Arroyo, V; Kamath, PS; Moreau, R; Jalan, R; Gines, P; Nevens, F; Fernandez, J; To, U; Garcia-Tsao, G; Schnabl, B; - view fewer (2016) Acute-on-Chronic Liver Failure: Definition, Diagnosis, and Clinical Characteristics. Seminars in Liver Disease , 36 (2) pp. 109-116. 10.1055/s-0036-1583202.

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Abstract

Acute-on-chronic liver failure (ACLF) is a recently recognized syndrome in cirrhosis characterized by acute decompensation (AD), organ failure(s), and high short-term mortality. Organ failure(s) is defined by the Chronic Liver Failure-Sequential Organ Failure (CLIF-SOFA) score or by its simplified version Chronic Liver Failure-Organ Failure Assessment (CLIF-OF) score. They include six types of organ failure: liver, renal, coagulation, cerebral, respiratory, and circulatory. One third of patients hospitalized with AD present with ACLF at admission or develop ACLF during hospitalization. Acute-on-chronic liver failure frequently occurs in a closed relationship to a precipitating event. According to the number of organ failures, ACLF is graded into three stages: ACLF-1 = single renal failure or single nonrenal organ failure if associated with renal dysfunction and/or cerebral dysfunction; ACLF-2 = two organ failures; and ACLF-3 = three to six organ failures, with increasing 28-day mortality rate (from 23%–74%). Acute-on-chronic liver failure may develop at any phase during the clinical course of the disease. Patients without prior AD develop a severe form of ACLF.

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