Management of acute decompensated cirrhosis

Acute decompensated cirrhosis (AD) refers to the development of ascites, encephalopathy, gastrointestinal haemorrhage, or any combination of these disorders in a patient with known or previously undiagnosed advanced chronic liver disease. It carries a significant mortality, particularly if associated with organ failure (acute on chronic liver failure (ACLF)). Admissions with AD have increased by 50% over the last decade, and liver-related deaths have increased by 64% in the last 20 years. UK-wide reports and audits, including by the National Confidential Enquiry into Patient Outcome and Death, have revealed unwarranted variation in care and outcomes for patients with AD. This article summarises the management of patients admitted with AD, including the British Society of Gastroenterology (BSG) / British Association for the Study of the Liver (BASL) / Society of Acute Medicine (SAM) decompensated cirrhosis care bundle, developed for completion in the first 6 h of admission to standardise care for these complex patients.