Acute-on-chronic Liver Failure

@article{Sarin2016AcuteonchronicLF,
  title={Acute-on-chronic Liver Failure},
  author={Shiv Kumar Sarin and Ashok Choudhury},
  journal={Current Gastroenterology Reports},
  year={2016},
  volume={18},
  pages={1-16}
}
Acute-on-chronic liver failure (ACLF) is a distinct entity that differs from acute liver failure and decompensated cirrhosis in timing, presence of treatable acute precipitant, and course of disease, with a potential for self-recovery. The core concept is acute deterioration of existing liver function in a patient of chronic liver disease with or without cirrhosis in response to an acute insult. The insult should be a hepatic one and presentation in the form of liver failure (jaundice… 

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References

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Acute-on-chronic liver failure: terminology, mechanisms and management

Acute-on-chronic liver failure (ACLF) is a distinct clinical entity and differs from acute liver failure and decompensated cirrhosis in timing, presence of acute precipitant, course of disease and

Acute-on-chronic liver failure: an update

TLDR
Using a liver-adapted sequential organ assessment failure score, it is possible to triage and prognosticate the outcome of patients with ACLF and bioartificial liver support systems, granulocyte-colony stimulating factors or stem-cell transplant are in the horizon of medical care; however, data are too premature to implement them as standard of care.

Management of acute-on-chronic liver failure: an algorithmic approach

TLDR
The present review provides an algorithmic approach to management of organ failure, sepsis prevention, use of dynamic prognostic models for management decision and is aimed to improve the skills for managing and improving the outcomes of such critically ill patients.

Acute-on-chronic liver failure in cirrhosis

TLDR
Liver and renal failures are the most common organ failures, followed by coagulation, brain, circulatory and respiratory failure, and ACLF can be reversed using standard therapy in only 16–51% of patients, leaving a considerable proportion of patients with ACLF that remains steady or progresses.

Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis.

TLDR
Diagnostic criteria for ACLF was established and showed that it is distinct from AD, based not only on the presence of organ failure(s) and high mortality rate but also on age, precipitating events, and systemic inflammation.

Acute-on-Chronic Liver Failure Before Liver Transplantation: Impact on Posttransplant Outcomes

TLDR
A single-center retrospective cohort study of 332 patients to evaluate the effect of ACLF, defined as an acute rise in the Model for End-Stage Liver Disease score of more than 5 within 4 weeks before transplantation, on posttransplant outcomes including stage 4 chronic kidney disease, death, recurrent cirrhosis, or graft failure requiring retransplantation.

Pattern and profile of chronic liver disease in acute on chronic liver failure

TLDR
Non-alcoholic fatty liver disease related chronic liver insult in patients with known risk factors for progressive disease should be taken as a chronic liver disease in the setting of ACLF, whereas fatty liver with normal aminotransferases in low risk patients should not.

Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure.

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