Acute Liver Failure

Clin Liver Dis. 2017 Nov;21(4):769-792. doi: 10.1016/j.cld.2017.06.002. Epub 2017 Jul 29.


Acute liver failure (ALF) is a life-threatening condition of heterogeneous etiology. Outcomes are better with early recognition and prompt initiation of etiology-specific therapy, intensive care protocols, and liver transplantation (LT). Prognostic scoring systems include the King's College Criteria and Model for End-stage Liver Disease score. Cerebral edema and intracranial hypertension are reasons for high morbidity and mortality; hypertonic saline is suggested for patients with a high risk for developing intracranial hypertension, and when it does, mannitol is recommended as first-line therapy. Extracorporeal liver support system may serve as a bridge to LT and may increase LT-free survival in select cases.

Keywords: Acute liver failure; Cerebral edema; Encephalopathy; Extracorporeal liver support system; Liver dialysis; Liver transplantation; N-acetylcysteine.

Publication types

  • Review

MeSH terms

  • Acetylcysteine / therapeutic use
  • Brain Edema / drug therapy
  • Brain Edema / etiology
  • Brain Edema / prevention & control*
  • Chemical and Drug Induced Liver Injury / complications
  • Chemical and Drug Induced Liver Injury / therapy*
  • Clinical Protocols
  • Critical Care
  • Disease Management
  • Diuretics, Osmotic / therapeutic use
  • Free Radical Scavengers / therapeutic use*
  • Hepatic Encephalopathy
  • Humans
  • Intracranial Hypertension / drug therapy
  • Intracranial Hypertension / etiology
  • Intracranial Hypertension / prevention & control*
  • Liver Failure, Acute / complications
  • Liver Failure, Acute / therapy*
  • Liver Transplantation*
  • Mannitol / therapeutic use
  • Saline Solution, Hypertonic / therapeutic use*
  • Time Factors


  • Diuretics, Osmotic
  • Free Radical Scavengers
  • Saline Solution, Hypertonic
  • Mannitol
  • Acetylcysteine