Managing Multiorgan Failure in Acute on Chronic Liver Failure

Enrico Pompili; Giulia Iannone; Daniele Carrello; Giacomo Zaccherini; Maurizio Baldassarre; Paolo Caraceni

doi:10.1055/a-2448-0664

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2024; 44(04): 492-509
DOI: 10.1055/a-2448-0664

Review Article

Managing Multiorgan Failure in Acute on Chronic Liver Failure

Enrico Pompili

¹Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

²Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

,

Giulia Iannone

¹Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

²Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

,

Daniele Carrello

¹Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

²Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

,

Giacomo Zaccherini

¹Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

²Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

,

Maurizio Baldassarre

²Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

,

Paolo Caraceni

¹Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

²Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

› Author Affiliations

Abstract

Acute-on-chronic liver failure (ACLF) is defined as a clinical syndrome that develops in patients with chronic liver disease characterized by the presence of organ failure and high short-term mortality, although there is still no worldwide consensus on diagnostic criteria. Management of ACLF is mainly based on treatment of “precipitating factors” (the most common are infections, alcohol-associated hepatitis, hepatitis B flare, and bleeding) and support of organ failure, which often requires admission to the intensive care unit. Liver transplantation should be considered in patients with ACLF grades 2 to 3 as a potentially life-saving treatment. When a transplant is not indicated, palliative care should be considered after 3 to 7 days of full organ support in patients with at least four organ failures or a CLIF-C ACLF score of >70. This review summarizes the current knowledge on the management of organ failure in patients with ACLF, focusing on recent advances.

Keywords

ACLF - acute decompensation - cirrhosis - hepatology - liver transplantation

Full Text

References

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