Copyright
©The Author(s) 2015.
World J Hepatol. Nov 8, 2015; 7(25): 2571-2577
Published online Nov 8, 2015. doi: 10.4254/wjh.v7.i25.2571
Published online Nov 8, 2015. doi: 10.4254/wjh.v7.i25.2571
Table 1 Diagnostic criteria of acute-on-chronic liver failure as per the chronic liver failure acute-on-chronic liver failure in cirrhosis study
No ACLF - This group consists of 3 subgroups |
Patients with no organ failure |
Patients with a single "non-kidney" organ failure (i.e., single failure of the liver, coagulation, circulation, or respiration) who had a serum creatinine level < 1.5 mg/dL and no hepatic encephalopathy |
Patients with single cerebral failure who had a serum creatinine level < 1.5 mg/dL |
ACLF grade 1 - This group consists of 3 subgroups |
Patients with single kidney failure |
Patients with single failure of the liver, coagulation, circulation, or respiration who had a serum creatinine level ranging from 1.5 to 1.9 mg/dL and/or mild to moderate hepatic encephalopathy |
Patients with single cerebral failure who had a serum creatinine level ranging from 1.5 and 1.9 mg/dL |
ACLF grade 2 - This group consists of patients with 2 organ failures |
ACLF grade 3 - This group consists of patients with 3 organ failures or more |
Definitions of organ failures - CANONIC study |
Liver failure - serum bilirubin level of 12.0 mg/dL or more |
Kidney failure - serum creatinine level of 2.0 mg/dL or more, or the use of renal replacement therapy |
Cerebral failure - grade III or IV hepatic encephalopathy |
Coagulation failure - an international normalized ratio of more than 2.5 and/or a platelet count of 20 × 109/L or less |
Circulatory failure - use of dopamine, dobutamine, or terlipressin |
Respiratory failure - ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (FiO2) of 200 or less or a pulse oximetric saturation to FiO2 ratio of 200 or less |
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 |
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 |
Table 4 Subtypes of acute-on-chronic liver failure as per World Gastroenterology Organization working party
Type A ACLF - non-cirrhotic chronic liver disease with an acute flare; often indistinguishable from acute or sub-acute liver failure |
Reactivation of hepatitis B |
Hepatitis A or E superimposed on chronic hepatitis B |
Autoimmune hepatitis |
Hepatitis E infection in patients at risk for NASH |
Type B ACLF - well compensated cirrhosis with an acute insult |
Type C ACLF - cirrhosis with previous hepatic decompensation |
- Citation: Singh H, Pai CG. Defining acute-on-chronic liver failure: East, West or Middle ground? World J Hepatol 2015; 7(25): 2571-2577
- URL: https://www.wjgnet.com/1948-5182/full/v7/i25/2571.htm
- DOI: https://dx.doi.org/10.4254/wjh.v7.i25.2571