title: Acute-on-chronic liver failure: Pathogenesis, prognostic factors and management.
abstract: Acute-on-chronic liver failure (ACLF) is increasingly recognized as a complex syndrome that is reversible in many cases. It is characterized by an acute deterioration of liver function in the background of a pre-existing chronic liver disease often associated with a high short-term mortality rate. Organ failure (OF) is always associated, and plays a key role in determining the course, and the outcome of the disease. The definition of ACLF remains controversial due to its overall ambiguity, with several disparate criteria among various associations dedicated to the study of liver diseases. Although the precise pathogenesis needs to be clarified, it appears that an altered host response to injury might be a contributing factor caused by immune dysfunction, ultimately leading to a pro-inflammatory status, and eventually to OF. The PIRO concept (Predisposition, Insult, Response and Organ Failure) has been proposed to better approach the underlying mechanisms. It is accepted that ACLF is a different and specific form of liver failure, where a precipitating event is always involved, even though it cannot always be ascertained. According to several studies, infections and active alcoholism often trigger ACLF. Viral hepatitis, gastrointestinal haemorrhage, or drug induced liver injury, which can also provoke the syndrome. This review mainly focuses on the physiopathology and prognostic aspects. We believe these features are essential to further understanding and providing the rationale for improveddisease management strategies.
authors.affiliation: Sara Blasco-Algora, José Masegosa-Ataz, María Luisa Gutiérrez-García, Sonia Alonso-López, Conrado M Fernández-Rodríguez, Service of Gastroenterology, Hospital Universitario Fundación, 28922 Alcorcón, Madrid, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Blasco-Algora
authors.affiliation: Sara Blasco-Algora, José Masegosa-Ataz, María Luisa Gutiérrez-García, Sonia Alonso-López, Conrado M Fernández-Rodríguez, Service of Gastroenterology, Hospital Universitario Fundación, 28922 Alcorcón, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Masegosa-Ataz
authors.affiliation: Sara Blasco-Algora, José Masegosa-Ataz, María Luisa Gutiérrez-García, Sonia Alonso-López, Conrado M Fernández-Rodríguez, Service of Gastroenterology, Hospital Universitario Fundación, 28922 Alcorcón, Madrid, Spain.
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Gutiérrez-García
authors.affiliation: Sara Blasco-Algora, José Masegosa-Ataz, María Luisa Gutiérrez-García, Sonia Alonso-López, Conrado M Fernández-Rodríguez, Service of Gastroenterology, Hospital Universitario Fundación, 28922 Alcorcón, Madrid, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Alonso-López
authors.affiliation: Sara Blasco-Algora, José Masegosa-Ataz, María Luisa Gutiérrez-García, Sonia Alonso-López, Conrado M Fernández-Rodríguez, Service of Gastroenterology, Hospital Universitario Fundación, 28922 Alcorcón, Madrid, Spain.
authors.forename: Conrado M
authors.initials: CM
authors.lastname: Fernández-Rodríguez
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D018450:Disease Progression; D006801:Humans; D008099:Liver / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Acute decompensation of cirrhosis; Acute on-chronic liver failure; Chronic liver failure-sequential organ failure assessment; Hepatic encephalopathy; Hepatorenal syndrome; Immune dysfunction; Liver failure; Organ failure; Severity score; Systemic inflammatory response