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Liver Diseases pp 381-394 | Cite as

Chronic Liver Failure and Acute-on-Chronic Liver Failure

  • Rita Garcia-Martinez
  • Raquel Diaz-Ruiz
  • Jesus Millan
  • Rafael Bañares
Chapter

Abstract

Chronic liver failure (CLF) is the result of persistent liver damage. Given the multifaceted abilities of the organ, CLF is a multisystem progressive disease that evolves from an asymptomatic (compensated) to a clinically manifested phase (decompensated) driven by hemodynamic disturbances and systemic inflammation. Among the whole spectrum, several stages with prognostic relevance have been described. Clinical management of CLF aims to treat primary liver disease, screening, prevent and controlling the complications, and consider liver transplantation (LT) in advanced stages and life-threatening complications. Improvement and reversibility of liver damage and clinical consequences have been described with etiological cure.

Acute-on-chronic liver failure (ACLF) is an acute decompensation characterized by high short-term mortality related to the development of organ failure. Systemic inflammatory response seems to play a key role. Despite its high risk of short-term mortality, it is a very dynamic syndrome and potentially reversible. Management includes early treatment of potential triggers, prevention of progression and support of failed organs and consider for LT. Since there is very limited data on the impact of ACLF on LT outcomes, its clinical applicability remains controversial.

Keywords

Liver cirrhosis Chronic liver failure Portal hypertension Acute-on-chronic liver failure Liver transplantation Human 

Abbreviations

ACLF

Acute-on-chronic liver failure

AKI

Acute kidney injury

BCLC

Barcelona clinic liver cancer

BT

Bacterial translocation

cACLD

Compensated advanced chronic liver disease

CLF

Chronic liver failure

CRP

C-reactive protein

Crs

Serum creatinine

DAMP

Damage-associated molecular pattern

DM

Diabetes mellitus

GA

Glutaminase

GS

Glutamine synthetase

HCC

Hepatocellular carcinoma

HE

Hepatic encephalopathy

HPS

Hepatopulmonary syndrome

HRS

Hepatorenal syndrome

LT

Liver transplantation

LVP

Large volume paracentesis

MELD

Model for end-stage liver disease

NAFLD

Non-alcoholic fatty liver disease

NSAIDs

Nonsteroidal anti-inflammatory drugs

NSBB

Non-selective beta blockers

PAMP

Pathogen-associated molecular pattern

PH

Portal hypertension

PPHT

Portopulmonary hypertension

PSS

Portosystemic shunts

SBP

Spontaneous bacterial peritonitis

TIPS

Transjugular intrahepatic portosystemic shunt

Notes

Acknowledgement

Conflict of interest: None.

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Rita Garcia-Martinez
    • 1
    • 2
    • 3
    • 4
  • Raquel Diaz-Ruiz
    • 5
    • 6
  • Jesus Millan
    • 1
    • 6
  • Rafael Bañares
    • 2
    • 3
    • 5
    • 6
  1. 1.Servicio de Medicina InternaHospital General Universitario Gregorio MarañónMadridSpain
  2. 2.Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
  3. 3.Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)MadridSpain
  4. 4.Facultad de MedicinaUniversidad San Pablo CEUMadridSpain
  5. 5.Servicio de Aparato DigestivoHospital General Universitario Gregorio MarañónMadridSpain
  6. 6.Facultad de MedicinaUniversidad Complutense MadridMadridSpain

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