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Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
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Acute-on-chronic liver failure.

Rahul Kumar1, Gautam Mehta2, Rajiv Jalan3

  • 1Changi General Hospital, Singapore.

Clinical Medicine (London, England)
|September 16, 2020
PubMed
Summary
This summary is machine-generated.

Acute-on-chronic liver failure (ACLF) is a serious condition in cirrhosis patients with high mortality. Early identification and organ support are crucial for managing this syndrome, distinct from acute decompensation.

Keywords:
Acute-on-chronic liver failureacute decompensationhigh short-term mortalityliver cirrhosisorgan failure

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Area of Science:

  • Hepatology
  • Critical Care Medicine
  • Internal Medicine

Background:

  • Acute-on-chronic liver failure (ACLF) is a distinct syndrome in cirrhosis patients, characterized by organ failures and high short-term mortality (>15% at 28 days).
  • ACLF differs from acute decompensation (AD) due to intense systemic inflammation, affecting liver, kidney, brain, coagulation, respiratory, and circulatory systems.
  • Organ failures are quantified using the European Association for the Study of the Liver Chronic Liver Failure Consortium (CLIF-C) OF score.

Purpose of the Study:

  • To define Acute-on-chronic liver failure (ACLF) and its distinction from acute decompensation (AD) in cirrhosis.
  • To highlight the central role of systemic inflammation in ACLF pathophysiology.
  • To emphasize the importance of early identification and supportive therapy for ACLF.

Main Methods:

  • Definition of ACLF based on organ failures (OFs) using the CLIF-C OF score.
  • Identification of common precipitating events in Western (bacterial infection, alcohol) and Eastern (hepatitis B flare, sepsis, alcohol) populations.
  • Assessment of the dynamic and reversible nature of ACLF, guiding treatment strategies.

Main Results:

  • ACLF is characterized by multiple organ failures, with high short-term mortality.
  • Bacterial infection and alcohol intake are frequent triggers in the West; hepatitis B flare and sepsis in the East. Approximately 40% of cases lack a clear precipitant.
  • Prognosis is often clear within 3-7 days of hospitalization, with the CLIF-C ACLF score being a key prognostic tool.

Conclusions:

  • ACLF requires prompt recognition and aggressive organ support, as specific therapies are limited (except liver transplantation).
  • The CLIF-C ACLF score is the most reliable prognostic indicator currently available.
  • Early intervention is critical for improving outcomes in patients with ACLF.