Acute-on-chronic liver failure: a review

Figures & data

Figure 1 Clinical course of cirrhosis.

Abbreviations: EV, esophageal varices; HE, hepatic encephalopathy; HVPG, hepatic venous pressure gradient; ACLF, acute-on-chronic liver failure.

Table

ACLF grade	Characteristics
	Acute liver damage associated with
Grade 1	Single kidney failurea OR liver failure,b coagulopathy,c circulatory failure,d respiratory failure,e serum creatinine 1.5–1.9 mg/dL and/or mild to moderate hepatic encephalopathy OR brain failuref with creatinine 1.5–1.9 mg/dL
Grade 2	Two organ failures
Grade 3	Three or more organ failures

Notes: CLIF-SOFA criteria (modified SOFA score considering aspects of chronic liver damage; this score was validated to be used in this study, based on authors’ experience) per organ

a serum creatinine ≥2 mg/dL or kidney replacement therapy

b total bilirubin ≥12

c International Normalized Ratio ≥2.5 or platelets 20 × 10⁹/L

d use of dopamine, dobutamine, terlipressin, norepinephrine, epinephrine

e PaO/FiO₂ ≤200 mg/dL or SpO₂/FiO₂ ≤214 mg/dL

f hepatic encephalopathy grade III or IV. Data from from Moreau et al.¹¹

Abbreviations: ACLF, acute-on-chronic liver failure; CLIF, Chronic Liver Failure; SOFA, Sequential Organ Failure Assessment.

Figure 2 Clinical course of acute-on-chronic liver failure.

Abbreviations: AKI, acute kidney injury; HRS, hepatorenal syndrome; MOF, multiple organ failure.

Table

Subgroups	Mortality rate at 28 days	Mortality rate at 90 days
ALD alonea	4.7%	14%
ACLF grade 1	22.1%	40.7%
ACLF grade 2	32%	52.3%
ACLF grade 3	76.7%	79.1%

Notes: CLIF-SOFA criteria

a ALD without organ failure or ALD with only one organ failure (liver, circulatory, or respiratory failure, or coagulopathy), other than kidney failure, and without encephalopathy, or ALD and brain failure with serum creatinine ≤1.5 mg/dL. Data from Moreau et al.¹¹

Abbreviations: ACLF, acute-on-chronic liver failure; ALD, acute liver disease; CLIF, Chronic Liver Failure; SOFA, Sequential Organ Failure Assessment.

MoreauRJalanRGinesPAcute on chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosisGastroenterology20131441426143723474284

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