title: [Acute-on-chronic liver failure (ACLF) is a separate clinical entity].
abstract: Acute-on-chronic liver failure (ACLF) is a condition that may develop in up to one third of patients with chronic liver disease who exhibit clinical signs of acute decompensation, i.e. ascites, gastrointestinal bleeding, hepatic encephalopathy or bacterial infection. ACLF implies the combination of acute hepatic decompensation with organ failure in kidney, brain, liver, lungs, circulation and/or coagulation. The prognosis worsens with the number of failing organs, renal involvement, advanced age and elevated leukocyte blood count. ACLF is caused by a systemic inflammation. Cultures from blood, urine and ascites should be drawn, and rapid antibiotic treatment is essential to prevent ACLF development. Renal function must be monitored and renal failure treated promptly. Acute alcoholic hepatitis may be considered a specific case of ACLF, which may be treated with corticosteroids in cases having high score in prognostic indices (GAHS, MELD or ABIC), and after bacterial infections have been ruled out or treated.
authors.affiliation: Karolinska Institutet - Gastroenterology and Hepatology Stockholm, Sweden Karolinska Institutet - Gastroenterology and Hepatology Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Stål
authors.affiliation: Karolinska Universitetssjukhuset - Gastrocentrum Stockholm, Sweden Karolinska Universitetssjukhuset - Gastrocentrum Stockholm, Sweden.
authors.forename: Antti
authors.initials: A
authors.lastname: Oksanen
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000150:complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006519:Hepatitis, Alcoholic / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D011379:Prognosis