Acute-on-chronic liver failure: Controversies and consensus

Area of Science:

• Hepatology
• Critical Care Medicine

Background:

• Acute-on-chronic liver failure (ACLF) is a syndrome of rapid deterioration in patients with chronic liver disease.
• ACLF is associated with high short-term morbidity, mortality, and significant healthcare resource utilization.
• A dysregulated systemic inflammatory response in ACLF can lead to extrahepatic organ failures.

Purpose of the Study:

• To provide clarity on controversies and consensus in Acute-on-chronic liver failure (ACLF).
• To review epidemiology, clinical and diagnostic features, management strategies, and research gaps in ACLF.
• To address the impact of heterogeneous definitions and diagnostic criteria on ACLF diagnosis and management.

Main Methods:

• This is a review article.
• It synthesizes current knowledge on ACLF from international hepatology societies.
• Key areas covered include epidemiology, clinical presentation, diagnosis, management, and future research directions.

Main Results:

• Heterogeneous definitions and diagnostic criteria for ACLF lead to diagnostic delays, variable clinical management, and underestimation of disease burden.
• Common precipitants of ACLF include infection, alcoholic hepatitis, and viral hepatitis reactivation.
• Organ support in intensive care units is the mainstay of ACLF treatment, with liver transplantation as a potential consideration.

Conclusions:

• There is a need for standardized definitions and diagnostic criteria for ACLF to improve patient outcomes.
• Further research is required to address current gaps in understanding and managing ACLF.
• Clarifying consensus and controversies in ACLF is crucial for optimizing patient care and resource allocation.