Arroyo, V;
Moreau, R;
Kamath, PS;
Jalan, R;
Gines, P;
Nevens, F;
Fernandez, J;
... Schnabl, B; + view all
(2016)
Acute-on-chronic liver failure in cirrhosis.
Nature Reviews Disease Primers
, 2
, Article 16041. 10.1038/nrdp.2016.41.
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Abstract
The definition of acute-on-chronic liver failure (ACLF) remains contested. In Europe and North America, the term is generally applied according to the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium guidelines, which defines this condition as a syndrome that develops in patients with cirrhosis and is characterized by acute decompensation, organ failure and high short-term mortality. One-third of patients who are hospitalized for acute decompensation present with ACLF at admission or develop the syndrome during hospitalization. ACLF frequently occurs in a closed temporal relationship to a precipitating event, such as bacterial infection or acute alcoholic, drug-induced or viral hepatitis. However, no precipitating event can be identified in approximately 40% of patients. The mechanisms of ACLF involve systemic inflammation due to infections, acute liver damage and, in cases without precipitating events, probably intestinal translocation of bacteria or bacterial products. ACLF is graded into three stages (ACLF grades 1–3) on the basis of the number of organ failures, with higher grades associated with increased mortality. Liver and renal failures are the most common organ failures, followed by coagulation, brain, circulatory and respiratory failure. The 28-day mortality rate associated with ACLF is 30%. Depending on the grade, ACLF can be reversed using standard therapy in only 16–51% of patients, leaving a considerable proportion of patients with ACLF that remains steady or progresses. Liver transplantation in selected patients with ACLF grade 2 and ACLF grade 3 increases the 6-month survival from 10% to 80%.
| Type: | Article |
|---|---|
| Title: | Acute-on-chronic liver failure in cirrhosis |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1038/nrdp.2016.41 |
| Publisher version: | http://doi.org/10.1038/nrdp.2016.41 |
| 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, Medicine, General & Internal, General & Internal Medicine, SPONTANEOUS BACTERIAL PERITONITIS, PLACEBO-CONTROLLED TRIAL, TUMOR-NECROSIS-FACTOR, PERIPHERAL ARTERIAL VASODILATION, SEVERE ALCOHOLIC HEPATITIS, THERAPY IMPROVES SURVIVAL, ASIAN-PACIFIC ASSOCIATION, INNATE IMMUNE-SYSTEM, TNF-ALPHA PRODUCTION, HUMAN GUT MICROBIOME |
| 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/1555222 |
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