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Semin Liver Dis 2016; 36(02): 109-116
DOI: 10.1055/s-0036-1583202
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Acute-on-Chronic Liver Failure: Definition, Diagnosis, and Clinical Characteristics

Vicente Arroyo
1   Institut de Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
2   European Foundation for the Study of Chronic Liver Failure (EF-CLIF) and European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium, Barcelona, Spain
,
Rajiv Jalan
2   European Foundation for the Study of Chronic Liver Failure (EF-CLIF) and European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium, Barcelona, Spain
3   Liver Failure Group, Institute for Liver and Digestive Health, University College London, Royal Free Hospital, London, United Kingdom
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Publication History

Publication Date:
12 May 2016 (online)

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Abstract

Acute-on-chronic liver failure (ACLF) is a recently recognized syndrome in cirrhosis characterized by acute decompensation (AD), organ failure(s), and high short-term mortality. Organ failure(s) is defined by the Chronic Liver Failure-Sequential Organ Failure (CLIF-SOFA) score or by its simplified version Chronic Liver Failure-Organ Failure Assessment (CLIF-OF) score. They include six types of organ failure: liver, renal, coagulation, cerebral, respiratory, and circulatory. One third of patients hospitalized with AD present with ACLF at admission or develop ACLF during hospitalization. Acute-on-chronic liver failure frequently occurs in a closed relationship to a precipitating event. According to the number of organ failures, ACLF is graded into three stages: ACLF-1 = single renal failure or single nonrenal organ failure if associated with renal dysfunction and/or cerebral dysfunction; ACLF-2 = two organ failures; and ACLF-3 = three to six organ failures, with increasing 28-day mortality rate (from 23%–74%). Acute-on-chronic liver failure may develop at any phase during the clinical course of the disease. Patients without prior AD develop a severe form of ACLF.

Keywords

decompensated cirrhosis - organ failure - acute-on-chronic liver failure
 

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