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Semin Liver Dis 2024; 44(04): 492-509
DOI: 10.1055/a-2448-0664
Review Article

Managing Multiorgan Failure in Acute on Chronic Liver Failure

Enrico Pompili
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
2   Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
,
Giulia Iannone
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
2   Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
,
Daniele Carrello
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
2   Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
,
Giacomo Zaccherini
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
2   Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
,
Maurizio Baldassarre
2   Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
,
Paolo Caraceni
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
2   Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
› Author Affiliations Funding The authors received no financial support to produce this manuscript.
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Abstract

Acute-on-chronic liver failure (ACLF) is defined as a clinical syndrome that develops in patients with chronic liver disease characterized by the presence of organ failure and high short-term mortality, although there is still no worldwide consensus on diagnostic criteria. Management of ACLF is mainly based on treatment of “precipitating factors” (the most common are infections, alcohol-associated hepatitis, hepatitis B flare, and bleeding) and support of organ failure, which often requires admission to the intensive care unit. Liver transplantation should be considered in patients with ACLF grades 2 to 3 as a potentially life-saving treatment. When a transplant is not indicated, palliative care should be considered after 3 to 7 days of full organ support in patients with at least four organ failures or a CLIF-C ACLF score of >70. This review summarizes the current knowledge on the management of organ failure in patients with ACLF, focusing on recent advances.

Keywords

ACLF - acute decompensation - cirrhosis - hepatology - liver transplantation

Ethical Approval Statement

Not applicable.




Publication History

Accepted Manuscript online:
23 October 2024

Article published online:
14 November 2024

© 2024. Thieme. All rights reserved.

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