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Gut. 2017 Mar;66(3):541-553. doi: 10.1136/gutjnl-2016-312670. Epub 2017 Jan 4.

Acute-on-chronic liver failure: an update.

Hernaez R1, Solà E2,3,4, Moreau R5,6,7,8,9, Ginès P2,3,4.

Author information

1
Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
2
Liver Unit, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
3
Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
4
Centro d'Investigaciones Biomedicas en Red, enfermedades Hepaticas y Digestivas (CIBEReHD), Barcelona, Spain.
5
Inserm, U1149, Centre de Recerche sur l'inflammation (CRI), Paris, France.
6
Faculté de Médicine, Université Paris Diderot, Paris, France.
7
Départment Hospitalo-Universitaire (DHU) UNITY, Service d'Hépatologie, Hôpital Beaujon, AP-HP, Clichy, France.
8
Laboratoire d'Excellence (Labex) Inflamex, CUE Sorbonne Paris Cité, Paris, France.
9
European Foundation for the Study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain.

Abstract

Acute-on-chronic liver failure (ACLF) is a syndrome characterised by acute decompensation of chronic liver disease associated with organ failures and high short-term mortality. Alcohol and chronic viral hepatitis are the most common underlying liver diseases. Up to 40%-50% of the cases of ACLF have no identifiable trigger; in the remaining patients, sepsis, active alcoholism and relapse of chronic viral hepatitis are the most common reported precipitating factors. An excessive systemic inflammatory response seems to play a crucial role in the development of ACLF. Using a liver-adapted sequential organ assessment failure score, it is possible to triage and prognosticate the outcome of patients with ACLF. The course of ACLF is dynamic and changes over the course of hospital admission. Most of the patients will have a clear prognosis between day 3 and 7 of hospital admission and clinical decisions such as evaluation for liver transplant or discussion over goals of care could be tailored using clinical scores. Bioartificial liver support systems, granulocyte-colony stimulating factors or stem-cell transplant are in the horizon of medical care of this patient population; however, data are too premature to implement them as standard of care.

KEYWORDS:

LIVER CIRRHOSIS; LIVER FAILURE

Comment in

PMID:
28053053
PMCID:
PMC5534763
DOI:
10.1136/gutjnl-2016-312670
[Indexed for MEDLINE]
Free PMC Article

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