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Published on: November 27, 2019
Acute-on-Chronic Liver Failure
Jonel Trebicka1, Michael Praktiknjo, Kai-Henrik Peiffer
1Department of Medicine B, University Hospital Münster (UKM), Münster, Germany; Department of General, Abdominal and Transplantation Surgery, University Hospital Münster (UKM), Münster, Germany.
Insights
Acute on chronic liver failure (ACLF) is a severe complication of cirrhosis with high mortality. Liver transplantation is the only cure, but patient selection remains a challenge due to limited data.
Area of Science:
- Hepatology
- Critical Care Medicine
- Transplantation Surgery
Background:
- Cirrhosis, the end stage of chronic liver disease, frequently leads to portal hypertension and acute on chronic liver failure (ACLF).
- ACLF is characterized by acute decompensation and failure of multiple organ systems, including the liver, kidneys, and lungs, or hepatic encephalopathy.
- Cirrhosis impacts approximately 1% of hospital admissions in Germany, contributing to an estimated 1 million deaths globally each year.
Purpose of the Study:
- To review the current understanding of acute on chronic liver failure (ACLF) in the context of liver cirrhosis.
- To highlight the challenges and potential future directions in managing ACLF, particularly concerning treatment and transplantation.
Main Methods:
- A selective literature search was conducted in the NCBI database using keywords "liver cirrhosis" and "ACLF."
- International publications and relevant clinical guidelines published up to June 2024 were included in the review.
Main Results:
- ACLF affects 35% of patients hospitalized for decompensated cirrhosis, carrying a significant 28-day mortality rate of 45%.
- Common precipitating factors for ACLF include infection, alcohol overuse, bleeding, and drug-induced encephalopathy.
- Currently, no specific drugs or treatments are approved for ACLF itself; management focuses on addressing the underlying etiology and precipitating factors.
Conclusions:
- Liver transplantation represents the sole curative treatment for ACLF but is limited by a narrow therapeutic window and frequent contraindications.
- There is a critical need for prospective data to improve patient selection for liver transplantation and enhance post-transplantation survival rates.
Background:
Cirrhosis is the end stage of chronic liver disease. Cirrhosis causes portal hypertension, which, in turn, can lead to acute on chronic liver failure (ACLF), which is defined as acute decompensation combined with failure of the liver, coagulation system, kidneys, lungs, and/or circulatory system, or hepatic encephalopathy.
Methods:
This review is based on a selective literature search for international publications in the NCBI database using the keywords "liver cirrhosis" and "ACLF." Valid guidelines (up to June 2024) were also included.
Results:
Cirrhosis is present in approximately 1% of all hospital admissions in Germany, and complications of cirrhosis cause an estimated 1 million deaths worldwide each year. ACLF, the most severe form of decompensated liver cirrhosis, bears a 28-day mortality of 45% and affects 35% of all patients hospitalized for decompensated cirrhosis. Its precipitating factors are infection, alcohol overuse, bleeding, and drug-induced enceph alopathy (benzodiazepines or opioids). No drugs or other treatments for ACLF have been approved; only its etiology and precipitating factors are amenable to treatment.
Conclusion:
Liver transplantation is currently the only curative option for ACLF but is not suitable for all patients because of the narrow therapeutic window and the common presence of contraindications. Prospective data are lacking that would aid in the selection of patients for liver transplantation so that post-transplantation survival rates can be improved.
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