Defining acute-on-chronic liver failure: East, West or Middle ground?

Table 2 Principle differences in the definition and diagnostic criteria of acute-on-chronic liver failure between Asia-Pacific and West

	APASL definition	EASL-CLIF definition
Total bilirubin	5 mg/dL or more	12 mg/dL or more
INR	1.5 or more	2.5 or more
Hepatic encephalopathy	Any grade	Only grade III and IV
Ascites	May be present	Not included
Duration between insult and ACLF	4 wk	Not defined
Acute event - sepsis	No	Yes
Acute event - variceal bleeding	No unless producing jaundice and coagulopathy defining ACLF	Yes
Extra-hepatic organ involvement	No	Yes
What is chronic disease	Chronic liver disease with/without only compensated cirrhosis	Only cirrhosis, including those with prior decompensation

APASL: Asia-Pacific Association for the Study of Liver; EASL-CLIF: European Association for the Study of Liver-chronic Liver Failure; INR: International normalized ratio; ACLF: Acute-on-chronic liver failure.