Acute-on-chronic liver failure in patients with alcohol-related liver disease

J Hepatol. 2019 Feb;70(2):319-327. doi: 10.1016/j.jhep.2018.12.008.

Abstract

The spectrum of alcohol-related liver diseases (ALD) includes steatosis, steatohepatitis, progressive liver fibrosis, and cirrhosis. Acute-on-chronic liver failure (ACLF) is a recently defined entity that occurs in patients with chronic liver diseases and is characterised by acute decompensation, organ failures and a high risk of short-term mortality. Active alcohol consumption, alcoholic hepatitis and bacterial infections are the most frequent events precipitating the development of ACLF in the context of ALD (ALD-ACLF). The specific management of this entity remains unknown and the place of salvage liver transplantation controversial. This overview details the current knowledge on specific aspects of epidemiology, pathophysiology, prognosis and management of ALD-ACLF.

Keywords: Alcoholic hepatitis; Cirrhosis; Infection; Inflammation; Liver transplantation; Organ failure.

Publication types

  • Review

MeSH terms

  • Acute-On-Chronic Liver Failure / drug therapy
  • Acute-On-Chronic Liver Failure / epidemiology*
  • Acute-On-Chronic Liver Failure / etiology*
  • Acute-On-Chronic Liver Failure / physiopathology
  • Adrenal Cortex Hormones / therapeutic use
  • Alcohol Drinking / adverse effects*
  • Bacterial Infections / complications*
  • Cytokines / metabolism
  • Fecal Microbiota Transplantation
  • Female
  • Humans
  • Inflammation / immunology
  • Leukocytes / immunology
  • Liver Diseases, Alcoholic / complications*
  • Liver Transplantation
  • Macrophages / immunology
  • Male
  • Prognosis

Substances

  • Adrenal Cortex Hormones
  • Cytokines