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Review
. 2025 Feb 21;122(4):96-102.
doi: 10.3238/arztebl.m2024.0255.

Acute-on-Chronic Liver Failure

Jonel Trebicka  1 , Michael Praktiknjo, Kai-Henrik Peiffer, Andreas Pascher, Martin Sebastian Schulz, Frank Erhard Uschner
Affiliations
Review

Acute-on-Chronic Liver Failure

Jonel Trebicka et al. Dtsch Arztebl Int. .

Abstract

Background: Cirrhosis is the end stage of chronic liver disease. Cirrhosis causes portal hypertension, which, in turn, can lead to acute on chronic liver failure (ACLF), which is defined as acute decompensation combined with failure of the liver, coagulation system, kidneys, lungs, and/or circulatory system, or hepatic encephalopathy.

Methods: This review is based on a selective literature search for international publications in the NCBI database using the keywords "liver cirrhosis" and "ACLF." Valid guidelines (up to June 2024) were also included.

Results: Cirrhosis is present in approximately 1% of all hospital admissions in Germany, and complications of cirrhosis cause an estimated 1 million deaths worldwide each year. ACLF, the most severe form of decompensated liver cirrhosis, bears a 28-day mortality of 45% and affects 35% of all patients hospitalized for decompensated cirrhosis. Its precipitating factors are infection, alcohol overuse, bleeding, and drug-induced enceph alopathy (benzodiazepines or opioids). No drugs or other treatments for ACLF have been approved; only its etiology and precipitating factors are amenable to treatment.

Conclusion: Liver transplantation is currently the only curative option for ACLF but is not suitable for all patients because of the narrow therapeutic window and the common presence of contraindications. Prospective data are lacking that would aid in the selection of patients for liver transplantation so that post-transplantation survival rates can be improved.

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Figures

Figure 1
Figure 1
Course of liver cirrhosis and decompensation events (created using BioRender.com) GI bleeding, gastrointestinal bleeding; pos., possible
Figure 2
Figure 2
Schematic representation of organ failure in ACLF and severity grading according to EASL-CLIF criteria (created using BioRender.com) ACLF, acute-on-chronic liver failure; AD, acute decompensation; HE, hepatic encephalopathy; CNS, central nervous system
See this image and copyright information in PMC

References

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