Moreau, R;
Tonon, M;
Krag, A;
Angeli, P;
Berenguer, M;
Berzigotti, A;
Fernandez, J;
... Trebicka, J; + view all
(2023)
EASL Clinical Practice Guidelines on acute-on-chronic liver failure.
Journal of Hepatology
, 79
(2)
pp. 461-491.
10.1016/j.jhep.2023.04.021.
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Abstract
Acute-on-chronic liver failure (ACLF), which was described relatively recently (2013), is a severe form of acutely decompensated cirrhosis characterised by the existence of organ system failure(s) and a high risk of short-term mortality. ACLF is caused by an excessive systemic inflammatory response triggered by precipitants that are clinically apparent (e.g., proven microbial infection with sepsis, severe alcohol-related hepatitis) or not. Since the description of ACLF, some important studies have suggested that patients with ACLF may benefit from liver transplantation and because of this, should be urgently stabilised for transplantation by receiving appropriate treatment of identified precipitants, and full general management, including support of organ systems in the intensive care unit (ICU). The objective of the present Clinical Practice Guidelines is to provide recommendations to help clinicians recognise ACLF, make triage decisions (ICU vs. no ICU), identify and manage acute precipitants, identify organ systems that require support or replacement, define potential criteria for futility of intensive care, and identify potential indications for liver transplantation. Based on an in-depth review of the relevant literature, we provide recommendations to navigate clinical dilemmas followed by supporting text. The recommendations are graded according to the Oxford Centre for Evidence-Based Medicine system and categorised as ‘weak’ or ‘strong’. We aim to provide the best available evidence to aid the clinical decision-making process in the management of patients with ACLF.
| Type: | Article |
|---|---|
| Title: | EASL Clinical Practice Guidelines on acute-on-chronic liver failure |
| Location: | Netherlands |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.jhep.2023.04.021 |
| Publisher version: | https://doi.org/10.1016/j.jhep.2023.04.021 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Gastroenterology & Hepatology, Organ failure, inflammation, precipitating event, infection, alcohol-related hepatitis, critical care, organ support, sarcopenia, frailty, liver transplantation, prognosis, futility, mortality, COLONY-STIMULATING FACTOR, INTRAHEPATIC PORTOSYSTEMIC SHUNT, CHRONIC HEPATITIS-B, NONSELECTIVE BETA-BLOCKERS, ILL CIRRHOTIC-PATIENTS, SHORT-TERM MORTALITY, FACTOR G-CSF, AUTOIMMUNE HEPATITIS, ACUTE DECOMPENSATION, PORTAL-HYPERTENSION |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10177128 |
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