[Acute on chronic liver failure: more than just cirrhotic decompensation]

Acute on Chronic Liver Failure (ACLF) is an unfavorable form of cirrhotic disease progression, distinguished from decompensated cirrhosis by a very high short-term mortality associated with damage to one or more organs. The pathophysiology is based on an intense systemic inflammatory reaction, the triggering factor of which can be identified (infection, toxic agent, etc.) in around two thirds of cases. The analogy with sepsis has enabled us to derive prognostic scores linked to organ damage, and thus to better guide these patients, who most often require close monitoring. Treatment remains limited and relies on support for the affected organs. Given the poor prognosis of these patients, attitude discussions should also be part of early management.