title: Acute-on-Chronic Liver Failure: Definition, Diagnosis, and Clinical Characteristics.
abstract: Acute-on-chronic liver failure (ACLF) is a recently recognized syndrome in cirrhosis characterized by acute decompensation (AD), organ failure(s), and high short-term mortality. Organ failure(s) is defined by the Chronic Liver Failure-Sequential Organ Failure (CLIF-SOFA) score or by its simplified version Chronic Liver Failure-Organ Failure Assessment (CLIF-OF) score. They include six types of organ failure: liver, renal, coagulation, cerebral, respiratory, and circulatory. One third of patients hospitalized with AD present with ACLF at admission or develop ACLF during hospitalization. Acute-on-chronic liver failure frequently occurs in a closed relationship to a precipitating event. According to the number of organ failures, ACLF is graded into three stages: ACLF-1 = single renal failure or single nonrenal organ failure if associated with renal dysfunction and/or cerebral dysfunction; ACLF-2 = two organ failures; and ACLF-3 = three to six organ failures, with increasing 28-day mortality rate (from 23%-74%). Acute-on-chronic liver failure may develop at any phase during the clinical course of the disease. Patients without prior AD develop a severe form of ACLF.
authors.affiliation: Institut de Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
authors.affiliation: European Foundation for the Study of Chronic Liver Failure (EF-CLIF) and European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium, Barcelona, Spain.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Jalan
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D063305:Organ Dysfunction Scores; D051437:Renal Insufficiency / Q000150:complications; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000150:complications; D013577:Syndrome