Chronic liver failure
ICD-10 K72.1 · ICD-11 DB99.8

Treatment of Chronic Liver Failure in Liver Cirrhosis with Acute Decompensation and Organ Failure

Acute-on-chronic liver failure (ACLF) is a high-mortality syndrome occurring in patients with liver cirrhosis when acute decompensation is complicated by one or more organ failures. It demands urgent, structured clinical intervention.

Clinical Scenario

The diagnosis applies to a patient with cirrhosis who develops acute decompensation — such as worsening ascites, overt encephalopathy, gastrointestinal haemorrhage, non-obstructive jaundice, or bacterial infection — complicated by organ failure(s) associated with high short-term mortality.

Approach Overview

Management is centred on organ support and addressing precipitating factors, delivered in an intermediate or intensive care setting. The protocol defines specific interventions according to the organ systems involved. The full structured regimen, including criteria and sequencing, is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jhep.2018.03.024

The diagnosis of ACLF should be made in a patient with cirrhosis and AD (defined as the acute development or worsening of ascites, overt encephalopathy, GI-haemorrhage, non-obstructive jaundice and/or bacterial infections), when organ failure(s) involving high short-term mortality develop (II-2;1).

At present, there is no specific therapy for ACLF aside from antiviral therapy in patients with ACLF due to reactivation of HBV infection. Treatment of ACLF should be based on organ support and management of precipitants (see point below) and associated complications. Patients should be treated in intermediate care or intensive care settings.

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