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Updated: Apr 13, 2026

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Acute-on-Chronic Liver Failure: Recent Concepts.

Richard Moreau1, Rajiv Jalan2, Vicente Arroyo3

  • 1Inserm, U1149, Centre de Recherche sur l'Inflammation (CRI), Clichy and Paris, France ; UMRS1149, Université Paris Diderot-Paris 7, Paris, France ; Département Hospitalo-Universitaire (DHU) UNITY, Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France ; Laboratoire d'Excellence Inflamex, PRES Sorbonne Paris Cité, Paris, France ; EASL-CLIF Consortium, Hospital Clinic, Centro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas (CIBERehd), Barcelona, Spain.

Journal of Clinical and Experimental Hepatology
|May 6, 2015
PubMed
Summary

Acute-on-Chronic Liver Failure (ACLF) is a distinct syndrome from decompensated cirrhosis, characterized by systemic inflammation and high short-term mortality. Early ACLF in cirrhosis patients indicates greater severity.

Keywords:
ACLF, acute-on-chronic liver failureAD, acute decompensationCANONIC, Consortium Acute-on-Chronic Liver Failure in CirrhosisCLIF, chronic liver failureCRP, C-reactive proteinEASL, European Association for the Study of the LiverINR, international normalized ratioSBP, spontaneous bacterial peritonitisSOFA, sequential organ failure assessmentcirrhosisinflammationorgan failures

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Area of Science:

  • Hepatology
  • Critical Care Medicine
  • Internal Medicine

Background:

  • Cirrhosis patients hospitalized for acute complications face high short-term mortality.
  • Acute-on-Chronic Liver Failure (ACLF) describes this high-risk patient group.
  • An evidence-based definition for ACLF was lacking until recently.

Purpose of the Study:

  • To define Acute-on-Chronic Liver Failure (ACLF) based on a large European study.
  • To differentiate ACLF from decompensated cirrhosis.
  • To understand the dynamics and characteristics of ACLF.

Main Methods:

  • Prospective observational study across Europe.
  • Utilized the European Association for the Study of the Liver (EASL)-Chronic Liver Failure (CLIF) Consortium CANONIC study data.
  • Analysis of patient outcomes and clinical characteristics.

Main Results:

  • ACLF is a distinct syndrome, separate from decompensated cirrhosis.
  • ACLF is dynamic, with potential for improvement or rapid decline leading to death.
  • Precipitating events are not essential for ACLF definition and do not solely determine outcomes.
  • Systemic inflammation is a key feature of ACLF, even without identifiable triggers.
  • ACLF can occur with recent or no prior decompensation, with early ACLF being more severe.

Conclusions:

  • The CANONIC study provided the first evidence-based definition of ACLF.
  • ACLF is a complex syndrome involving systemic inflammation and dynamic progression.
  • Understanding ACLF is crucial for managing high-risk cirrhosis patients and improving outcomes.