Update on acute-on-chronic liver failure

Gastroenterol Hepatol. 2018 Jan;41(1):43-53. doi: 10.1016/j.gastrohep.2017.05.012. Epub 2017 Jun 24.
[Article in English, Spanish]

Abstract

Acute-on-chronic liver failure (ACLF) is a recently defined syndrome characterised by acute decompensation of chronic liver disease, associated with organ failures and high mortality. ACLF is a common condition and may affect up to 30% of patients admitted to hospital for cirrhosis complications. Bacterial infections, alcoholism and reactivation of viral hepatitis are the most common precipitating factors in ACLF, although in up to 40% of patients no precipitating factor can be identified. Although the pathophysiology of ACLF is not completely understood, the presence of an excessive inflammatory response appears to play a key role. There is no specific treatment for patients with ACLF and management is based on organ support and liver transplantation. New treatment strategies based on liver support systems and immunomodulatory treatments are being evaluated but existing data are still limited.

Keywords: Acute-on-chronic liver failure; Cirrhosis; Cirrosis; Inflamación; Inflammation; Insuficiencia hepática aguda sobre crónica; Liver transplantation; Trasplante hepático.

Publication types

  • Review

MeSH terms

  • Acute-On-Chronic Liver Failure* / epidemiology
  • Acute-On-Chronic Liver Failure* / etiology
  • Acute-On-Chronic Liver Failure* / physiopathology
  • Acute-On-Chronic Liver Failure* / therapy
  • Alarmins / physiology
  • Algorithms
  • Bacterial Translocation
  • Granulocyte Colony-Stimulating Factor / therapeutic use
  • Hepatitis, Viral, Human / complications
  • Humans
  • Immunologic Factors / therapeutic use
  • Liver Cirrhosis / complications
  • Liver Diseases, Alcoholic / complications
  • Liver Transplantation
  • Multiple Organ Failure / etiology
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Receptors, Pattern Recognition / physiology
  • Risk Factors
  • Severity of Illness Index

Substances

  • Alarmins
  • Immunologic Factors
  • Receptors, Pattern Recognition
  • Granulocyte Colony-Stimulating Factor