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Acute-on-chronic liver failure.
Clin Gastroenterol Hepatol. 2015 Jul 15;
Authors: Asrani SK, Simonetto DA, Kamath PS
Abstract
Over the last two decades, the concept of acute-on-chronic liver failure (ACLF) has been proposed as an alternate path in the natural history of decompensated cirrhosis. ACLF is thus characterized by the presence of a precipitating event (identified or unidentified) in subjects with underlying chronic liver disease leading to rapid progression of liver injury and ending in multi-organ dysfunction characterized by high short term mortality. Multiple organ failure and increased risk for mortality are key to diagnosis of ACLF. The prevalence of ACLF ranges from 24-40% in hospitalized patients. The pathophysiological basis of ACLF can be explained using a 4 part model of predisposing event, injury due to precipitating event, response to injury and organ failure. Though several mathematical scores have been proposed for identifying outcomes with ACLF, it is yet unclear whether these organ failure scores are truly prognostic or are only reflective of the dying process. Treatment paradigms continue to evolve but consist of early recognition, supportive intensive care, and consideration of liver transplantation prior to onset of irreversible multiple organ failure.
PMID: 26188138 [PubMed - as supplied by publisher]