Abstract
Acute-on-chronic liver failure (ACLF) is a clinical entity that is well recognized by those who care for patients with cirrhosis, however in spite of this widespread recognition, there remains little consensus with regard to definition and clinical features. While many similarities exist between ACLF and decompensated cirrhosis, there are also key differences, the implications of which are far reaching for both clinicians and patients alike. Among these differences are the possibility of a reversible component, the presence of a defined insult, prognosis, and outcomes associated with ACLF (see Fig. 1). However, for ACLF to have meaningful clinical implications, it first must be defined. If ACLF can be clearly defined and more easily recognized, then clinicians may be better able to prevent, treat, prognosticate, and counsel such patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Vong S, Bell BP. Chronic liver disease mortality in the United States, 1990–1998. Hepatology. 2004;39:476–83.
Gines P, Quintero E, Arroyo V, et al. Compensated cirrhosis: natural history and prognostic factors. Hepatology. 1987;7:122–8.
Ripoll C, Groszmann R, Garcia-Tsao G, et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology. 2007;133:481–8.
Kamath PS. Scoring severity of chronic liver disease. J Gastroenterol Hepatol. 2002;17 Suppl 3:S298–299.
D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–31.
• Olson JC, Kamath PS: Acute-on-chronic liver failure: concept, natural history, and prognosis. Current Opinion in Critical Care 2011;17:165–169. A recent review article that expands the concept of ACLF.
Jalan R, Stadlbauer V, Sen S, et al. Natural history of acute decompensation of cirrhosis: the basis of the definition, prognosis, and pathophysiology of acute-on-chronic liver failure. Hepatology. 2006;44 Suppl 1:371A–2A.
• Donovan JP, Schafer DF, Shaw BW, Jr., Sorrell MF: Cerebral oedema and increased intracranial pressure in chronic liver disease. Lancet 1998;351:719–721. A manuscript describing the presence of cerebral edema in patients with decompensated chronic liver disease, a phenomenon which is considered rare.
Larson AM, Curtis JR. Integrating palliative care for liver transplant candidates: “too well for transplant, too sick for life”. JAMA: the Journal of the American Medical Association. 2006;295:2168–76.
Disclosure
No potential conflicts of interest relevant to this article were reported.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Olson, J.C., Kamath, P.S. Acute-on-Chronic Liver Failure: What are the Implications?. Curr Gastroenterol Rep 14, 63–66 (2012). https://doi.org/10.1007/s11894-011-0228-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11894-011-0228-2