Acute-On-Chronic Liver Failure

• Acute-on-chronic liver failure (ACLF) is defined as an acute deterioration of liver function in a patient with cirrhosis that is associated with organ failure and has high short-term mortality.
• Key extrahepatic organ failures in ACLF include the renal, CNS, respiratory, circulatory, and coagulation systems.
• With respect to CNS failure in ACLF:
  • Hepatic encephalopathy (HE) is the most common manifestation
  • A normal ammonia level makes HE unlikely
  • Benzodiazepines should be avoided
  • Primary triggers for HE include infection, GIB, and aggressive diuresis
  • Treatment of HE primarily consists of lactulose and rifaximin

References

Perricone G, et al. Intensive care management of acute-on-chronic liver failure. Critical Care. 2023;49:903-21.