Zhang YY, Meng ZJ. Definition and classification of acute-on-chronic liver diseases. World J Clin Cases 2022; 10(15): 4717-4725 [PMID: 35801045 DOI: 10.12998/wjcc.v10.i15.4717]
Corresponding Author of This Article
Zhong-Ji Meng, MD, Chief Doctor, Full Professor, Research Scientist, Institute of Biomedical Research, Hubei Key Laboratory of Embryonic Stem Cell Research, Taihe Hospital, Hubei University of Medicine, No. 32 South Renmin Road, Shiyan 442000, Hubei Province, China. zhongji.meng@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
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 Clin Cases. May 26, 2022; 10(15): 4717-4725 Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.4717
Definition and classification of acute-on-chronic liver diseases
Yuan-Yao Zhang, Zhong-Ji Meng
Yuan-Yao Zhang, Postgraduate Training Basement of Jinzhou Medical University, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
Zhong-Ji Meng, Institute of Biomedical Research, Hubei Key Laboratory of Embryonic Stem Cell Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
Zhong-Ji Meng, Department of Infectious Diseases, Hubei Clinical Research Center for Precise Diagnosis and Therapy of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
Author contributions: Zhang YY wrote the manuscript; Meng ZJ contributed to the conception of the study and revised the manuscript.
Supported bythe National Science and Technology Major Project, No. 2018ZX10723203 and No. 2018ZX10302206; the Foundation for Innovative Research Groups of Hubei Provincial Natural Science Foundation, No. 2018CFA031; the Project of Hubei University of Medicine, No. FDFR201902, No. 2020XGFYZR05, and No. YC2020015; and the Project of Science and Technology Plan of Shiyan, No. 20Y08 and No. 19Y27.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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: Zhong-Ji Meng, MD, Chief Doctor, Full Professor, Research Scientist, Institute of Biomedical Research, Hubei Key Laboratory of Embryonic Stem Cell Research, Taihe Hospital, Hubei University of Medicine, No. 32 South Renmin Road, Shiyan 442000, Hubei Province, China. zhongji.meng@163.com
Received: November 1, 2021 Peer-review started: November 1, 2021 First decision: December 26, 2021 Revised: January 10, 2022 Accepted: March 25, 2022 Article in press: March 25, 2022 Published online: May 26, 2022
Abstract
Patients with chronic liver diseases (CLDs) develop acute liver injury and/or acute decompensation under the attack of various precipitants and present with significantly elevated alanine aminotransferase and/or total bilirubin levels, liver failure, or acute decompensation of liver cirrhosis, which is called acute-on-CLD (AoCLD). AoCLD accounts for the majority of patients hospitalized in the Department of Hepatology or Infectious Diseases. AoCLD is complicated by various clinical types, the severity of the disease, and may pose a high risk of death. To date, the definition of AoCLD is still vague, and a consensus concept of the clinical classification is lacking. This review aimed to define the concept and clinical types of AoCLD based on related studies and the literature.
Core Tip: Acute–on-chronic liver disease (AoCLD) can be defined as a group of diseases that experience acute liver injury (ALI) or acute decompensation in patients with pre-existing chronic liver disease (CLD). AoCLD can be divided into acute-on-chronic liver failure (ACLF) and non-ACLF according to the degree of ALI and the presence or absence of organ failure. According to the basic state of CLD, ACLF can be classified as type A (on the basis of chronic hepatitis), type B (on the basis of compensatory cirrhosis), and type C (on the basis of decompensated cirrhosis), and non-ACLF can be further classified as chronic hepatitis with acute exacerbation, the active phase of liver cirrhosis, and liver cirrhosis-acute decompensation.
