UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Acute-on-chronic liver failure in cirrhosis

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. Green open access

[thumbnail of Jalan_Acute-on-chronic liver failure in cirrhosis Final draft nature review YL 31Aug2017.pdf]
Preview
Text
Jalan_Acute-on-chronic liver failure in cirrhosis Final draft nature review YL 31Aug2017.pdf - Accepted Version

Download (543kB) | Preview

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
Downloads since deposit
369Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item