Critical Care Management of Acute-on-Chronic Liver Failure: Certainties and Unknowns

Enric Reverter; David Toapanta; Octavi Bassegoda; Juliana Zapatero; Javier Fernandez

doi:10.1055/s-0043-1769907

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2023; 43(02): 206-217
DOI: 10.1055/s-0043-1769907

Review Article

Critical Care Management of Acute-on-Chronic Liver Failure: Certainties and Unknowns

Enric Reverter^*

¹Liver ICU, Liver Unit, Hospital Clinic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain

,

David Toapanta^*

¹Liver ICU, Liver Unit, Hospital Clinic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain

,

Octavi Bassegoda^*

¹Liver ICU, Liver Unit, Hospital Clinic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain

,

Juliana Zapatero^*

¹Liver ICU, Liver Unit, Hospital Clinic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain

,

Javier Fernandez^*

¹Liver ICU, Liver Unit, Hospital Clinic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain

²European Foundation for the Study of Chronic Liver Failure, EASL-CLIF, Consortium, Barcelona, Spain

› Author Affiliations

Abstract

Intensive care unit (ICU) admission is frequently required in patients with decompensated cirrhosis for organ support. This entity, known as acute-on-chronic liver failure (ACLF), is associated with high short-term mortality. ICU management of ACLF is complex, as these patients are prone to develop new organ failures and infectious or bleeding complications. Poor nutritional status, lack of effective liver support systems, and shortage of liver donors are also factors that contribute to increase their mortality. ICU therapy parallels that applied in the general ICU population in some complications but has differential characteristics in others. This review describes the current knowledge on critical care management of patients with ACLF including organ support, prognostic assessment, early liver transplantation, and futility rules. Certainties and knowledge gaps in this area are also discussed.

Keywords

prognosis - mortality - transplantation - liver support - infection

Full Text

References

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