Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 8, 2015; 7(25): 2571-2577
Published online Nov 8, 2015. doi: 10.4254/wjh.v7.i25.2571
Defining acute-on-chronic liver failure: East, West or Middle ground?
Harneet Singh, C Ganesh Pai
Harneet Singh, C Ganesh Pai, Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal, Karnataka 576104, India
Author contributions: Singh H and Pai CG conceived the issues which formed the content of the manuscript and wrote the manuscript.
Conflict-of-interest statement: The authors have no conflict of interests.
Open-Access: 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/
Correspondence to: Dr. C Ganesh Pai, MD, DM, Professor and Head, Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Madhav Nagar, Near Tiger Circle, Manipal, Karnataka 576104, India. cgpai@yahoo.co.in
Telephone: +91-820-2922192 Fax: +91-820-2571934
Received: May 27, 2015
Peer-review started: May 30, 2015
First decision: July 27, 2015
Revised: August 13, 2015
Accepted: October 16, 2015
Article in press: October 19, 2015
Published online: November 8, 2015
Processing time: 165 Days and 18.9 Hours
Abstract

Acute-on-chronic liver failure (ACLF), a newly recognized clinical entity seen in hospitalized patients with chronic liver disease including cirrhosis, is associated with high short- and medium term morbidity and mortality. None of the definitions of ACLF proposed so far have been universally accepted, the two most commonly used being those proposed by the Asia-Pacific Association for the Study of Liver (APASL) and the European Association for the Study of Liver - Chronic Liver Failure (EASL-CLIF) consortium. On paper both definitions and diagnostic criteria appear to be different from each other, reflecting the differences in cut-off values for individual parameters used in diagnosis, the acute insult or precipitating event and the underlying chronic liver disease. Data directly comparing these two criteria are limited, and available studies reveal different outcomes when the two are applied to the same set of patients. However a review of the literature suggests that both definitions do not seem to identify the same set of patients. The definition given by the APASL consortium is easier to apply in day-to-day practice but the EASL-CLIF criteria appear to better predict mortality in ACLF. The World Gastroenterology Organization working party have proposed a working definition of ACLF which will identify patients from whom relevant data can be collected so that the similarities and the differences between the two regions, if any, can be clearly defined.

Keywords: Acute-on-chronic liver failure; Chronic liver disease; Cirrhosis; Ascites; Hepatic encephalopathy

Core tip: Acute-on-chronic liver failure, a relatively new clinical entity seen in patients with chronic liver disease including cirrhosis, is associated with high morbidity and mortality. The two most commonly used definitions given by the Asia-Pacific Association for the Study of Liver and the European Association for the Study of Liver - Chronic Liver Failure consortium, are different and appear to identify different set of patients. Because of limited data on these definitions, the World Gastroenterology Organization working party has proposed a new definition to identify patients from whom data can be collected to ultimately arrive at a uniform definition.