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Review
. 2021 Feb;116(1):3-16.
doi: 10.1007/s00063-019-00613-x. Epub 2019 Aug 28.

[Treatment strategies for acute-on-chronic liver failure]

[Article in German]
A-R Kabbani, T L Tergast, M P Manns, B Maasoumy  1
Affiliations
Review

[Treatment strategies for acute-on-chronic liver failure]

[Article in German]
A-R Kabbani et al. Med Klin Intensivmed Notfmed. 2021 Feb.

Abstract
in English, German

Acute-on-chronic liver failure (ACLF) is a newly defined syndrome in patients with liver cirrhosis characterized by acute hepatic decompensation (jaundice, ascites, hepatic encephalopathy, bacterial infection and gastrointestinal bleeding), single or multiple organ failure and a high mortality (>15% within 28 days). The affected organ systems include not only the liver but also the circulation, lungs, kidneys, brain and/or coagulation. Pathophysiologically decisive is an uncontrolled inflammation that is induced by specific triggers and on the basis of previously (possibly not diagnosed) compensated as well as already decompensated liver cirrhosis leads to a severe systemic clinical syndrome, ACLF. The course during the first 72 h is decisive for the prognosis. In addition to treatment of the respective organ or system failure, the underlying triggers should be quickly identified and if necessary specifically treated. Often, however, these cannot (no longer) be determined with any certainty, in particular recent alcohol consumption as well as bacterial and viral infections play an important role. A specific treatment for the ACLF is (currently) not established. Some experimental approaches are currently being tested, including administration of granulocyte colony-stimulating factor (GCSF). Additionally, suitable patients should be presented to a liver transplantation center in a timely manner.

Das akut-auf-chronische Leberversagen (ACLF) ist ein Syndrom bei Patienten mit Leberzirrhose bestehend aus akuter hepatischer Dekompensation (Ikterus, Aszites, hepatische Enzephalopathie, bakterielle Infektion, gastrointestinale Blutung), einem Ein- oder Mehrorganversagen und hoher Mortalität (>15 % innerhalb von 28 Tagen). Die betroffenen Organsysteme umfassen neben der Leber auch Kreislauf, Lunge, Niere, Gehirn und/oder Gerinnung. Pathophysiologisch entscheidend ist eine unkontrollierte Inflammation, welche durch Auslöser („Trigger“) sowohl bei zuvor (möglicherweise bislang nicht diagnostizierter) kompensierter als auch bei bereits dekompensierter Leberzirrhose zu einem systemischen Krankheitsbild, dem ACLF, führt. Für die Prognose ist der Verlauf der ersten 72 h entscheidend. Neben der Therapie des jeweiligen Organ- oder Systemversagens sollten die Trigger rasch identifiziert und ggf. spezifisch behandelt werden. Häufig sind diese aber nicht (mehr) sicher zu eruieren, insbesondere spielen ein kürzlicher Alkoholkonsum sowie eine bakterielle oder virale Infektion eine wichtige Rolle. Eine spezifische Therapie für das ACLF ist (zurzeit) nicht etabliert. Aktuell werden einige experimentelle Ansätze, u. a. die Gabe von G‑CSF, untersucht. Geeignete Patienten sollten zudem frühzeitig in einem Lebertransplantationszentrum vorgestellt werden.

Keywords: ACLF; Acute on chronic liver failure; Hepatic decompensation; Liver cirrhosis; Liver failure.

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