Ngu NLY, Flanagan E, Bell S, Le ST. Acute-on-chronic liver failure: Controversies and consensus. World J Gastroenterol 2023; 29(2): 232-240 [PMID: 36687118 DOI: 10.3748/wjg.v29.i2.232]
Corresponding Author of This Article
Natalie LY Ngu, MBBS, Doctor, Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Road, Clayton 3168, Victoria, Australia. natalie.ngu@monash.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 14, 2023; 29(2): 232-240 Published online Jan 14, 2023. doi: 10.3748/wjg.v29.i2.232
Acute-on-chronic liver failure: Controversies and consensus
Natalie L Y Ngu, Eliza Flanagan, Sally Bell, Suong T Le
Natalie L Y Ngu, Eliza Flanagan, Sally Bell, Suong T Le, Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, Victoria, Australia
Natalie L Y Ngu, Eliza Flanagan, Sally Bell, Suong T Le, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton 3800, Victoria, Australia
Natalie L Y Ngu, Department of Gastroenterology and Hepatology, Alfred Health, Melbourne 3004, Victoria, Australia
Eliza Flanagan, Suong T Le, Monash digital Therapeutics and Innovation Laboratory (MoTILa), Monash University, Clayton 3168, Victoria, Australia
Author contributions: Ngu NLY and Flanagan E contributed equally to this work; Ngu NLY, Flanagan E, Bell S, and Le S were involved in the conception and design of the article; Ngu NLY and Flanagan E undertook a literature review and initial draft; all authors were involved in the writing and editing of the article; all authors reviewed the final manuscript before submission.
Conflict-of-interest statement: There are no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Natalie LY Ngu, MBBS, Doctor, Department of Gastroenterology and Hepatology, Monash Health, Level 3, 246 Clayton Road, Clayton 3168, Victoria, Australia. natalie.ngu@monash.edu
Received: September 27, 2022 Peer-review started: September 27, 2022 First decision: October 17, 2022 Revised: November 1, 2022 Accepted: December 21, 2022 Article in press: December 21, 2022 Published online: January 14, 2023 Processing time: 99 Days and 15.7 Hours
Abstract
Acute-on-chronic liver failure (ACLF) is a poorly defined syndrome characterised by rapid clinical deterioration in patients with chronic liver disease. Consequences include high short-term morbidity, mortality, and healthcare resource utilisation. ACLF encompasses a dysregulated, systemic inflammatory response, which can precipitate extra hepatic organ failures. Common precipitants include infection, alcoholic hepatitis, and reactivation of viral hepatitis although frequently no cause is identified. Heterogenous definitions, diagnostic criteria, and treatment guidelines, have been proposed by international hepatology societies. This can result in delayed or missed diagnoses of ACLF, significant variability in clinical management, and under-estimation of disease burden. Liver transplantation may be considered but the mainstay of treatment is organ support, often in the intensive care unit. This review will provide clarity around where are the controversies and consensus in ACLF including: Epidemiology and resource utilisation, key clinical and diagnostic features, strategies for management, and research gaps.
Core Tip: Acute-on-chronic liver failure is characterised by rapid clinical deterioration in patients with chronic liver disease. Consequences include high short-term morbidity, mortality, and healthcare resource use. Heterogenous definitions, diagnostic criteria, and treatment guidelines create further challenges to optimal care. This review summarises epidemiology and resource utilisation, key clinical features, strategies for management, and research gaps.
