Critical care hepatology: A narrative review of current concepts and management

Patients with advanced liver disease requiring intensive care were long considered to have limited benefit from aggressive treatment, given the high associated mortality. Over recent decades, outcomes have improved with advances in liver transplantation, critical care, and a better understanding of multiorgan failure. Acute liver failure and acute-on-chronic liver failure are now recognized as complex multisystem syndromes in which survival is determined not only by hepatic dysfunction but also by extrahepatic organ failure, systemic inflammation, and infection. Critical care hepatology has therefore evolved as a clinical discipline integrating hepatology, intensive care, and transplant medicine. Modern management requires adaptation of conventional intensive care strategies to the distinct pathophysiological features of liver failure syndromes, together with coordinated multidisciplinary care, often delivered within specialized liver intensive care units. Despite substantial progress, important challenges remain, including limitations of current prognostic models, ongoing debate surrounding transplant allocation policies, and complex decisions regarding transplant candidacy and futility. A structured approach to critical care hepatology may improve care integration and outcomes in critically ill patients with liver disease.