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

Acute-on-chronic liver failure (ACLF) is a distinct, high-mortality syndrome occurring in patients with underlying liver cirrhosis who develop acute decompensation and one or more organ failures. Prompt clinical recognition and rapid escalation of care are critical.

Clinical Scenario

This protocol applies to patients with liver cirrhosis presenting with acute decompensation — including acute-onset or worsening ascites, overt encephalopathy, gastrointestinal haemorrhage, non-obstructive jaundice, or bacterial infection — in whom organ failure(s) develop and short-term mortality is high (ACLF).

Treatment Approach

Management in this setting involves urgent specialist-level evaluation, with early referral to a liver transplant centre as a central component of the approach.

The complete structured regimen — including full evaluation criteria, management steps, and transplant pathway details — is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

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).

Early referral of patients with ACLF to liver transplant centres for immediate evaluation is recommended (II-3;1).

DOI: 10.1016/j.jhep.2018.03.024

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