Overview on acute-on-chronic liver failure

doi:10.1007/s11684-016-0439-x

Front. Med.

2016, Vol. 10

Issue (1) : 1-17 https://doi.org/10.1007/s11684-016-0439-x

REVIEW

Overview on acute-on-chronic liver failure

Jing Zhang^1,³,Shan Gao^2,³,Zhongping Duan^2,^3,^*(

),Ke-Qin Hu^4,^*(

)

1. Department of Hepatitis C and Drug Induced Liver Injury, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
2. Beijing Artificial Liver Treatment & Training Center, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
3. Collaborative Innovation Center of Infectious Diseases, Beijing 100069, China
4. Division of Gastroenterology and Hepatology, University of California, Irvine, Medical Center, Orange, CA 92868, USA

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Abstract

Liver failure (LF) is defined as severe dysfunction in hepatic synthesis, detoxification, and metabolism induced by various etiologies. Clinical presentation of LF typically includes severe jaundice, coagulation disorder, hepatic encephalopathy, and ascites. LF can be classified into acute LF, acute-on-chronic LF (ACLF), and chronic LF. ACLF has been demonstrated as a distinct syndrome with unique clinical presentation and outcomes. The severity, curability, and reversibility of ACLF have attracted considerable attention. Remarkable developments in ACLF-related conception, diagnostic criteria, pathogenesis, and therapy have been achieved. However, this disease, especially its diagnostic criteria, remains controversial. In this paper, we systemically reviewed the current understanding of ACLF from its definition, etiology, pathophysiology, pathology, and clinical presentation to management by thoroughly comparing important findings between east and west countries, as well as those from other regions. We also discussed the controversies, challenges, and needs for future studies to promote the standardization and optimization of the diagnosis and treatment for ACLF.

Keywords liver failure chronic liver failure acute-on-chronic liver failure diagnosis prognosis treatment

Corresponding Author(s): Zhongping Duan,Ke-Qin Hu

Just Accepted Date: 25 February 2016 Online First Date: 16 March 2016 Issue Date: 31 March 2016

Cite this article:

Jing Zhang,Shan Gao,Zhongping Duan, et al. Overview on acute-on-chronic liver failure[J]. Front. Med., 2016, 10(1): 1-17.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-016-0439-x
https://academic.hep.com.cn/fmd/EN/Y2016/V10/I1/1

Tab.1 Clinical presentation and diagnostic criteria of three different types of liver failure (LF)

Tab.2 Comparison of ACLF diagnostic criteria by CMA, APASL, and EASL-AASLD

Fig.1 Pathogenesis for different types of acute-on-chronic liver failure (ACLF) (Adopted from reference [24] with permission from Elsevier). Three types of ACLF are suggested. Type A ACLF is non-cirrhotic ACLF, type B is cirrhotic ACLF, and type C is cirrhotic ACLF with previous hepatic decompensation.

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