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Lancet. 2015 Oct 17;386(10003):1576-87. doi: 10.1016/S0140-6736(15)00309-8. Epub 2015 Sep 27.

Acute-on-chronic liver failure.

Author information

1
Liver Intensive Therapy Unit, King's College Hospital, London, UK. Electronic address: william.bernal@kcl.ac.uk.
2
Liver Failure Group, Division of Medicine, University College London, London, UK; Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK; Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK.
3
Histopathology Section, Institute of Liver Studies, King's College Hospital, London, UK.
4
Department of Hepatology, University of Edinburgh, Edinburgh, UK.
5
Liver Intensive Therapy Unit, King's College Hospital, London, UK.
6
Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK; Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK.

Abstract

Acute-on-chronic liver failure combines an acute deterioration in liver function in an individual with pre-existing chronic liver disease and hepatic and extrahepatic organ failures, and is associated with substantial short-term mortality. Common precipitants include bacterial and viral infections, alcoholic hepatitis, and surgery, but in more than 40% of patients, no precipitating event is identified. Systemic inflammation and susceptibility to infection are characteristic pathophysiological features. A new diagnostic score, the Chronic Liver Failure Consortium (CLIF-C) organ failure score, has been developed for classification and prognostic assessment of patients with acute-on-chronic liver failure. Disease can be reversed in many patients, and thus clinical management focuses upon the identification and treatment of the precipitant while providing multiorgan-supportive care that addresses the complex pattern of physiological disturbance in critically ill patients with liver disease. Liver transplantation is a highly effective intervention in some specific cases, but recipient identification, organ availability, timing of transplantation, and high resource use are barriers to more widespread application. Recognition of acute-on-chronic liver failure as a clinically and pathophysiologically distinct syndrome with defined diagnostic and prognostic criteria will help to encourage the development of new management pathways and interventions to address the unacceptably high mortality.

PMID:
26423181
DOI:
10.1016/S0140-6736(15)00309-8
[Indexed for MEDLINE]

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