Semin Liver Dis 2016; 36(02): 181-186
DOI: 10.1055/s-0036-1583203
Diagnostic Problems in Hepatology
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Case Report: Acute-on-Chronic Liver Failure: Making the Diagnosis between Infection and Acute Alcoholic Hepatitis

Carmen Sendra
1   Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen Macarena - Virgen del Rocío University Hospitals, University of Sevilla, Sevilla, Spain
,
Javier Ampuero
1   Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen Macarena - Virgen del Rocío University Hospitals, University of Sevilla, Sevilla, Spain
2   Instituto de Biomedicina de Sevilla, Spain
,
Álvaro Giráldez Gallego
1   Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen Macarena - Virgen del Rocío University Hospitals, University of Sevilla, Sevilla, Spain
,
José Manuel Sousa
1   Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen Macarena - Virgen del Rocío University Hospitals, University of Sevilla, Sevilla, Spain
,
María Serrano Jiménez
3   Pathology Unit, Virgen del Rocio University Hospital, Sevilla, Spain
,
Manuel Romero-Gómez
1   Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen Macarena - Virgen del Rocío University Hospitals, University of Sevilla, Sevilla, Spain
2   Instituto de Biomedicina de Sevilla, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
12 May 2016 (online)

Abstract

Acute-on-chronic liver failure (ACLF) represents a reversible syndrome associated with high short-term mortality, characterized by acute decompensation in patients with chronic liver disease and extrahepatic organ failure. Diagnosis and prognosis assessment is based on a newly developed diagnostic score, the Chronic Liver Failure Consortium Organ Failure score. Susceptibility to infections and systemic inflammation are typical triggers. The authors report a case in which a patient with alcohol-related cirrhosis was admitted to the hospital with acute decompensation and developed ACLF during hospitalization. This case led to an evaluation of the underlying process causing ACLF: infection versus acute alcoholic hepatitis.

 
  • References

  • 1 Arroyo V, Moreau R, Jalan R, Ginès P ; EASL-CLIF Consortium CANONIC Study. Acute-on-chronic liver failure: a new syndrome that will re-classify cirrhosis. J Hepatol 2015; 62 (1, Suppl): S131-S143
  • 2 Gustot T, Fernandez J, García E , et al; CANONIC Study Investigators of the EASL-CLIF Consortium. Clinical course of acute-on-chronic liver failure syndrome and effects on prognosis. Hepatology 2015; 62 (1) 243-252
  • 3 Jalan R, Ginès P, Olson JC , et al. Acute-on chronic liver failure. J Hepatol 2012; 57 (6) 1336-1348
  • 4 Bernal W, Jalan R, Quaglia A, Simpson K, Wendon J, Burroughs A. Acute-on-chronic liver failure. Lancet 2015; 386 (10003) 1576-1587
  • 5 Moreau R, Jalan R, Gines P , et al; CANONIC Study Investigators of the EASL–CLIF Consortium. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144 (7) 1426-1437 , 1437.e1–1437.e9
  • 6 Jalan R, Fernandez J, Wiest R , et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol 2014; 60 (6) 1310-1324
  • 7 Runyon BA. Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. Hepatology 1990; 12 (4 Pt 1): 710-715
  • 8 Katoonizadeh A, Laleman W, Verslype C , et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010; 59 (11) 1561-1569
  • 9 Jalan R, Saliba F, Pavesi M , et al; CANONIC study investigators of the EASL-CLIF Consortium. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol 2014; 61 (5) 1038-1047
  • 10 Mookerjee RP, Pavesi M, Thomsen KL , et al. Treatment with non-selective beta blockers is associated with reduced severity of systemic inflammation and improved survival of patients with acute-on-chronic liver failure. J Hepatol 2016; 64 (3) 574-582
  • 11 Mandorfer M, Bota S, Schwabl P , et al. Nonselective β blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. Gastroenterology 2014; 146 (7) 1680-90.e1
  • 12 Sersté T, Njimi H, Degré D , et al. The use of beta-blockers is associated with the occurrence of acute kidney injury in severe alcoholic hepatitis. Liver Int 2015; 35 (8) 1974-1982
  • 13 European Association for the Study of Liver. EASL clinical practical guidelines: management of alcoholic liver disease. J Hepatol 2012; 57 (2) 399-420
  • 14 Mathurin P, O'Grady J, Carithers RL , et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 2011; 60 (2) 255-260
  • 15 Thursz MR, Richardson P, Allison M , et al; STOPAH Trial. Prednisolone or pentoxifylline for alcoholic hepatitis. N Engl J Med 2015; 372 (17) 1619-1628