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

Table 3 Acute insult/precipitating event in patients with acute-on-chronic liver failure

As per APASL criteria	As per EASL-CLIF criteria
Hepatotropic viral infections	Bacterial infection
Reactivation of HBV	Gastrointestinal hemorrhage
HEV super-infection	Active alcoholism within the past 3 mo
Active alcohol consumption (within last 28 d)	Other precipitating events
Drug induced liver injury	Transjugular intrahepatic portosystemic shunting
Complimentary and alternative medicines	Major surgery
Severe autoimmune hepatitis	Therapeutic paracentesis without use of intravenous albumin
Flare of Wilson's disease	Hepatitis
Non-hepatotropic insults (if producing direct hepatic insult)	Alcoholic hepatitis (liver biopsy required for diagnosis)
Surgery	No precipitating event identified
Trauma
Viral infections
No acute insult identifiable

Adapted from Sarin et al[8] and Moreau et al[3]. ACLF: Acute-on-chronic liver failure; APASL: Asia-Pacific Association for the Study of Liver; EASL-CLIF: European Association for the Study of Liver-chronic Liver Failure; HEV: Hepatitis E virus; HBV: Hepatitis B virus.