Copyright
©The Author(s) 2021.
World J Hepatol. Oct 27, 2021; 13(10): 1289-1298
Published online Oct 27, 2021. doi: 10.4254/wjh.v13.i10.1289
Published online Oct 27, 2021. doi: 10.4254/wjh.v13.i10.1289
Table 1 Commonly accepted acute-on-chronic liver failure definitions
APASL | EASL | NASCELD | |
Definition | An acute hepatic insult manifesting as jaundice (serum bilirubin ≥ 5 mg/dL) and coagulopathy (INR ≥ 1.5) complicated within 4 wk by clinical ascites and/or encephalopathy in a patient with previously diagnosed or undiagnosed chronic liver disease/cirrhosis, and is associated with a high 28-d mortality | An acute deterioration of pre-existing chronic liver disease usually related to a precipitating event and associated with increased mortality at 3 mo due to multisystem organ failure | A syndrome characterized by acute deterioration of cirrhosis with two or more extrahepatic organ failure |
Included patients | Acute liver deterioration in patients with previously diagnosed or undiagnosed chronic liver disease including cirrhosis. Acute hepatic triggering factors | Cirrhosis (compensated or decompensated) | Cirrhosis (compensated or decompensated) |
Renal failure is mandatory | Two extrahepatic organ failure | ||
Patients with an acute decompensation of cirrhosis | Presentation not necessarily to be liver failure | ||
Patients with prior decompensation of cirrhosis | Can be repeated episodes of ACLF | ||
Excluded patients | Patients with bacterial infections | HCC | HIV infection |
Patients with cirrhosis who develop acute deterioration of their clinical status are considered to have acute decompensation but not ACLF | HIV infection | Disseminated malignancies | |
Prior decompensation.Non-hepatic acute insults (such as sepsis) | Receiving immunosuppressive treatments | ||
Pediatric definition | For children less than 3 years, modified HE assessment scale can be used | None | None |
Clinical and/or radiological ascites can be used for defining ACLF in children |
- Citation: Islek A, Tumgor G. Acute-on-chronic liver failure in children. World J Hepatol 2021; 13(10): 1289-1298
- URL: https://www.wjgnet.com/1948-5182/full/v13/i10/1289.htm
- DOI: https://dx.doi.org/10.4254/wjh.v13.i10.1289