Skip to main content

Liver Decompensation and Acute on Chronic Liver Failure

  • Chapter
  • First Online:
Liver Disease in Clinical Practice

Part of the book series: In Clinical Practice ((ICP))

  • 567 Accesses

Abstract

Acute on chronic liver failure (ACLF) is a distinct clinical syndrome that rapidly occurs in patients with pre-existing liver cirrhosis. It is defined by the number of extrahepatic organ failures and is associated with significant morbidity and short-term mortality risk. This chapter describes the principles of ACLF including the postulated pathophysiology of this syndrome, prognostication models and recent evidence based on principles of management including liver transplantation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 37.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 37.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Moreau R, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144(7):1426–37.

    Article  PubMed  Google Scholar 

  2. Jalan R, et al. Acute-on chronic liver failure. J Hepatol. 2012;57(6):1336–48.

    Article  PubMed  Google Scholar 

  3. Hernaez R, et al. Acute-on-chronic liver failure. Gut. 2017;66(66):541–53.

    Article  CAS  PubMed  Google Scholar 

  4. Jalan R, et al. The CLIF consortium acute decompensation score (CLIF-C ads) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure. J Hepatol. 2015;62(4):831–40.

    Article  PubMed  Google Scholar 

  5. Selvapatt N, et al. Understanding infection susceptibility in patients with acute-on-chronic liver failure. Intensive Care Med. 2014;40(9):1363–6.

    Article  PubMed  Google Scholar 

  6. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, European Association for the Study of the Liver. EASL guidelines, EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406–60. https://doi.org/10.1016/j.jhep.2018.03.024.

    Article  Google Scholar 

  7. Martin-Lhall M, et al. Prognostic importance of the cause of renal failure in patients with cirrhosis. Gastroenterology. 2011;140(2):488–96.

    Article  Google Scholar 

  8. European Association for the Study of the Liver. EASL guidelines, EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53(3):397–417.

    Article  Google Scholar 

  9. Villanueva C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013;368:11–21.

    Article  CAS  PubMed  Google Scholar 

  10. Chavez-Tapia NC, et al. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010;2010(9):CD002907.

    PubMed Central  Google Scholar 

  11. EASL guidelines, EASL clinical practice guidelines on hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the EASL and AASLD. J Hepatol. 2014;60(2):715–35.

    Google Scholar 

  12. Thursz MR, et al. Prednisolone or pentoxifylline for alcoholic hepatitis. N Engl J Med. 2015;372(17):1619–28.

    Article  CAS  PubMed  Google Scholar 

  13. Nguyen-Khac E, et al. Glucocorticoids plus N-acetylcysteine in severe alcoholic hepatitis. N Engl J Med. 2011;365:1781–9.

    Article  CAS  PubMed  Google Scholar 

  14. Mathurin P. Early liver transplantation for acute alcoholic hepatitis: We can’t say. J Hepatol. 2021;75:718–22.

    Article  PubMed  Google Scholar 

  15. Caraceni P, et al. Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomized trial. Lancet. 2018;391(10138):2417–29.

    Article  CAS  PubMed  Google Scholar 

  16. China L, et al. A randomized trial of albumin infusion in hospitalized patients with cirrhosis. N Engl J Med. 2021;384:808–17.

    Article  CAS  PubMed  Google Scholar 

  17. Northup P, et al. Coagulation in liver disease: a guide for the clinician. Clin Gastroenterol Hepatol. 2013;11:1064–74.

    Article  PubMed  Google Scholar 

  18. Moon DB, et al. Adult living donor liver transplantation for acute-on-chronic liver failure in high-model for end-stage liver disease score patients. Am J Transplant. 2017;17:1833–42.

    Article  PubMed  Google Scholar 

  19. Thuluvath PJ, et al. Liver transplantation in patients with multiple organ failures: feasibility and outcomes. J Hepatol. 2018;69:1047–56.

    Article  PubMed  Google Scholar 

  20. Sundaram V, et al. Factors associated with survival of patients with severe acute-on-chronic liver failure before and after liver transplantation. Gastroenterology. 2019;156(5):1381–1391.e3.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. Dhar .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Nathwani, R., Selvapatt, N., Dhar, A. (2022). Liver Decompensation and Acute on Chronic Liver Failure. In: Cross, T. (eds) Liver Disease in Clinical Practice. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-031-10012-3_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-10012-3_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-10011-6

  • Online ISBN: 978-3-031-10012-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics