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. 2022 May;52(5):417-421.
doi: 10.1111/hepr.13763.

Diagnostic criteria for acute-on-chronic liver failure and related disease conditions in Japan

Satoshi Mochida  1 , Nobuaki Nakayama  1 , Shuji Terai  2 , Hitoshi Yoshiji  3 , Masahito Shimizu  4 , Akio Ido  5 , Kazuaki Inoue  6 , Takuya Genda  7 , Yasuhiro Takikawa  8 , Taro Takami  9 , Naoya Kato  10 , Masanori Abe  11 , Ryuzo Abe  12 , Ayano Inui  13 , Hiromasa Ohira  14 , Mureo Kasahara  15 , Kazuaki Chayama  16 , Kiyoshi Hasegawa  17 , Atsushi Tanaka  18
Affiliations

Diagnostic criteria for acute-on-chronic liver failure and related disease conditions in Japan

Satoshi Mochida et al. Hepatol Res. 2022 May.

Abstract

The Intractable Hepato-Biliary Disease Study Group of Japan, sponsored by the Ministry of Health, Labor and Wealth, proposed in 2018 that patients with cirrhosis and a Child-Pugh score of 5-9 should be diagnosed as having acute-on-chronic liver failure (ACLF) when a deterioration of liver function ("serum bilirubin level of 5.0 mg/dl or more" and "prothrombin time value of 40% or less of the standardized values and/or international normalization rates of 1.5 or more") caused by severe liver damage develops within 28 days after an acute insult, including alcohol abuse, bacterial infection, gastrointestinal bleeding, and the exacerbation of underlying liver diseases. Disease severity can be classified into 4 grades depending on the extent of the deterioration in organ functions, including liver, kidney, cerebral, blood coagulation, circulatory and respiratory functions. The Study Group has since performed an annual nationwide survey of patients with ACLF diagnosed according to the proposed diagnostic criteria as well as those with disease conditions related to ACLF. A total of 501 patients, including 183 patients diagnosed as having ACLF, seen between 2017 and 2019 were enrolled, and univariate and multivariate analyses revealed that the proposed diagnostic criteria were useful for identifying cirrhotic patients with an unfavorable outcome following an acute insult. Consequently, the Study Group determined that the proposed diagnostic criteria should be used in both clinical practice and clinical research as formal diagnostic criteria.

Keywords: ACLF; diagnostic criteria; liver cirrhosis; multiple organ failure; severe alcoholic hepatitis.

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References

REFERENCES

    1. Sherlock S. Diseases of the liver and biliary system. 6th ed. Oxford: Blackwell Scientific Publication; 1981. p. 107-115.
    1. Sarin SK, Kumar A, Almeida JA, Chawla YK, Fan ST, Garg H, et al. Acute-on-chronic liver failure: consensus recommendation of the Asian Pacific association for the study of the liver (APASL). Hepatol Int. 2009;3:269-82.
    1. Sarin SK, Kedarisetty CK, Abbas Z, Amarapurkar D, Bihari C, Chan AC, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL) 2014. Hepatol Int. 2014;8:453-71.
    1. Sarin SK, Choudhury A, Sharma MK, Maiwall R, Al Mahtab M, Rahman S, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL); an update. Hepatol Int. 2019;3:353-90.
    1. Olson JC, Wendon JA, Kumaer DJ, Vicente A, Jalan R, Garcia-Taso G, et al. Intensive care of the patients with cirrhosis. Hepatology. 2011;54:1864-72.

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