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Acute-on-chronic liver failure.

Bernal, W; Jalan, R; Quaglia, A; Simpson, K; Wendon, J; Burroughs, A; (2015) Acute-on-chronic liver failure. In: UNSPECIFIED (pp. 1576-1587).

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Acute-on-chronic liver failure combines an acute deterioration in liver function in an individual with pre-existing chronic liver disease and hepatic and extrahepatic organ failures, and is associated with substantial short-term mortality. Common precipitants include bacterial and viral infections, alcoholic hepatitis, and surgery, but in more than 40% of patients, no precipitating event is identified. Systemic inflammation and susceptibility to infection are characteristic pathophysiological features. A new diagnostic score, the Chronic Liver Failure Consortium (CLIF-C) organ failure score, has been developed for classification and prognostic assessment of patients with acute-on-chronic liver failure. Disease can be reversed in many patients, and thus clinical management focuses upon the identification and treatment of the precipitant while providing multiorgan-supportive care that addresses the complex pattern of physiological disturbance in critically ill patients with liver disease. Liver transplantation is a highly effective intervention in some specific cases, but recipient identification, organ availability, timing of transplantation, and high resource use are barriers to more widespread application. Recognition of acute-on-chronic liver failure as a clinically and pathophysiologically distinct syndrome with defined diagnostic and prognostic criteria will help to encourage the development of new management pathways and interventions to address the unacceptably high mortality.

Type: Book chapter
Title: Acute-on-chronic liver failure.
DOI: 10.1016/S0140-6736(15)00309-8
Keywords: Acute-On-Chronic Liver Failure, Bacterial Infections, Blood Coagulation Disorders, Brain Diseases, Cardiovascular Diseases, Humans, Liver Transplantation, Organ Dysfunction Scores, Renal Insufficiency, Severity of Illness Index
UCL classification: UCL > School of Life and Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Medicine (Division of)
URI: http://discovery.ucl.ac.uk/id/eprint/56492
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