Acute-on-chronic liver failure: A new and important entity in the ICU

Abstract

Traditionally two types of liver failure were recognized: acute liver failure (ALF), characterized by a rapid deterioration of the liver function in the absence of a preexisting liver disease, and the progression with a slow deterioration over time of preexisting end-stage liver disease leading to an acute hepatic insult [1]. Recently, a new clinical form of liver failure has been described: Acute-on-chronic liver failure (ACLF). This new entity is characterized by acute complications of compensated or even decompensated cirrhosis with a high rate of organ failure and a high short-term mortality rate. ACLF is now an increasingly recognized entity in both the hepatology and critical care literature and poses several challenges to clinicians. In fact, the liver's position at the apex of multiple synthetic, detoxifying, metabolic, immunological, and hormonal processes predisposes patients with ACLF to a number of complications. The present review aims at summarizing the most updated knowledge about this particularly severe syndrome.