Skip to main content
SpringerLink
Log in

Acute-on-Chronic Liver Failure

  • Chapter
  • First Online:
Complications of Cirrhosis

  • 1936 Accesses

Abstract

Acute-on-chronic liver failure (ACLF) is a recently recognized syndrome in patients with cirrhosis and acute decompensation (AD) characterized by organ failure(s) and high short-term mortality (33 % within 28 days after diagnosis). The prevalence of ACLF in patients admitted to hospital with decompensated cirrhosis is 30 % (20 % of patients present ACLF at admission and 10 % develops the syndrome during hospitalization). According to the number of organ failures, there are three grades of severity: ACLF-1 (one organ failure; 28-day mortality rate 22 %), ACLF-2 (two organ failures; 28-day mortality rate 32 %); ACLF-3 (three to six organ failures; 28-day mortality rate 73 %). ACLF occurs in the setting of a systemic inflammation due to bacterial infections, acute liver injury, or to as-yet-unidentified factors. There is no specific treatment for ACLF. At present, these patients are managed by improving circulatory function with intravenous (i.v.) albumin and vasoconstrictors (in patients with hepatorenal syndrome), artificial organ support or liver transplantation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Jalan R, Gines P, Olson JC, et al. Acute-on chronic liver failure. J Hepatol. 2012;57:1336–48.

    Article  PubMed  Google Scholar 

  2. Sarin SK, Kumar A, Almeida JA, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int. 2009;3:269–82.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Bajaj JS. Defining acute-on-chronic liver failure: will East and West ever meet? Gastroenterology. 2013;144:1337–9.

    Article  PubMed  Google Scholar 

  4. Jalan R, Yurdaydin C, Bajaj JS, et al. Toward an improved definition of acute-on-chronic liver failure. Gastroenterology. 2014;147:4–10.

    Article  PubMed  Google Scholar 

  5. Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144:1426–37.

    Article  PubMed  Google Scholar 

  6. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10.

    Article  CAS  PubMed  Google Scholar 

  7. Wehler M, Kokoska J, Reulbach U, et al. Short-term prognosis in critically ill patients with cirrhosis assessed by prognostic scoring systems. Hepatology. 2001;34:255–61.

    Article  CAS  PubMed  Google Scholar 

  8. Das V, Boelle PY, Galbois A, et al. Cirrhotic patients in the medical intensive care unit: early prognosis and long-term survival. Crit Care Med. 2010;38:2108–16.

    Article  PubMed  Google Scholar 

  9. Levesque E, Hoti E, Azoulay D, et al. Prospective evaluation of the prognostic scores for cirrhotic patients admitted to an intensive care unit. J Hepatol. 2012;56:95–102.

    Article  PubMed  Google Scholar 

  10. Gustot T, Durand F, Lebrec D, et al. Severe sepsis in cirrhosis. Hepatology. 2009;50:2022–33.

    Article  CAS  PubMed  Google Scholar 

  11. Oettl K, Birner-Gruenberger R, Spindelboeck W, et al. Oxidative albumin damage in chronic liver failure: relation to albumin binding capacity, liver dysfunction and survival. J Hepatol. 2013;59:978–83.

    Article  CAS  PubMed  Google Scholar 

  12. Chan JK, Roth J, Oppenheim JJ, et al. Alarmins: awaiting a clinical response. J Clin Invest. 2012;122:2711–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Hoque R, Farooq A, Mehal WZ. Sterile inflammation in the liver and pancreas. J Gastroenterol Hepatol. 2013;28:61–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Wiest R, Lawson M, Geuking M. Pathological bacterial translocation in liver cirrhosis. J Hepatol. 2014;60:197–209.

    Article  PubMed  Google Scholar 

  15. Takeuchi O, Akira S. Pattern recognition receptors and inflammation. Cell. 2010;140:805–20.

    Article  CAS  PubMed  Google Scholar 

  16. Sutterwala FS, Ogura Y, Flavell RA. The inflammasome in pathogen recognition and inflammation. J Leukoc Biol. 2007;82:259–64.

    Article  CAS  PubMed  Google Scholar 

  17. Ruiz-del-Arbol L, Urman J, Fernández J, et al. Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology. 2003;38:1210–8.

    Article  PubMed  Google Scholar 

  18. Galley HF. Oxidative stress and mitochondrial dysfunction in sepsis. Br J Anaesth. 2011;107:57–64.

    Article  CAS  PubMed  Google Scholar 

  19. Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med. 2011;365: 147–56.

    Article  CAS  PubMed  Google Scholar 

  20. Gandoura S, Weiss E, Rautou PE, et al. Gene- and exon-expression profiling reveals an extensive LPS-induced response in immune cells in patients with cirrhosis. J Hepatol. 2013;58:936–48.

    Article  CAS  PubMed  Google Scholar 

  21. Gustot T, Durand F, Lebrec D, et al. Severe sepsis in cirrhosis. Hepatology. 2009;50:2022–33.

    Article  CAS  PubMed  Google Scholar 

  22. Cohen J. The immunopathogenesis of sepsis. Nature. 2002;420:885–91.

    Article  CAS  PubMed  Google Scholar 

  23. Levi M, Ten Cate H. Disseminated intravascular coagulation. N Engl J Med. 1999;341:586–92.

    Article  CAS  PubMed  Google Scholar 

  24. Coughlin SR. Thrombin signalling and protease-activated receptors. Nature. 2000;407:258–64.

    Article  CAS  PubMed  Google Scholar 

  25. Rautou PE, Bresson J, Sainte-Marie Y, et al. Abnormal plasma microparticles impair vasoconstrictor responses in patients with cirrhosis. Gastroenterology. 2012;143:166–76.

    Article  CAS  PubMed  Google Scholar 

  26. Lemoinne S, Thabut D, Housset C, et al. The emerging roles of microvesicles in liver diseases. Nat Rev Gastroenterol Hepatol. 2014;11:350–61.

    Article  CAS  PubMed  Google Scholar 

  27. Garcia-Martinez R, Caraceni P, Bernardi M, et al. Albumin: pathophysiologic basis of its role in the treatment of cirrhosis and its complications. Hepatology. 2013;58:1836–46.

    Article  CAS  PubMed  Google Scholar 

  28. Arroyo V, García-Martinez R, Salvatella X. Human serum albumin, systemic inflammation, and cirrhosis. J Hepatol. 2014;61:396–407.

    Google Scholar 

  29. Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999;341:403–9.

    Article  CAS  PubMed  Google Scholar 

  30. Moreau R, Lebrec D. The use of vasoconstrictors in patients with cirrhosis: type 1 HRS and beyond. Hepatology. 2006;43:385–94.

    Article  CAS  PubMed  Google Scholar 

  31. O’Brien AJ, Fullerton JN, Massey KA, et al. Immunosuppression in acutely decompensated cirrhosis is mediated by prostaglandin E2. Nat Med. 2014;20:518–23.

    Article  PubMed  Google Scholar 

  32. Bruschi M, Candiano G, Santucci L, et al. Oxidized albumin. The long way of a protein of uncertain function. Biochim Biophys Acta. 2013;1830:5473–9.

    Article  CAS  PubMed  Google Scholar 

  33. Arroyo V, Moreau R. Tying up PGE2 with albumin to relieve immunosuppression in cirrhosis. Nat Med. 2014;20:467–9.

    Article  CAS  PubMed  Google Scholar 

  34. Fitzpatrick FA, Liggett WF, Wynalda MA. Albumin-eicosanoid interactions. A model system to determine their attributes and inhibition. J Biol Chem. 1984;259:2722–7.

    CAS  PubMed  Google Scholar 

  35. Boulanger CM, Amabile N, Guérin AP, et al. In vivo shear stress determines circulating levels of endothelial microparticles in end-stage renal disease. Hypertension. 2007;49:902–8.

    Article  CAS  PubMed  Google Scholar 

  36. Vion AC, Ramkhelawon B, Loyer X, et al. Shear stress regulates endothelial microparticle release. Circ Res. 2013;112:1323–33.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Liver Unit, Institute of Digestive Diseases and Metabolism, University of Barcelona, Hospital Clinic—Villarroel 170, Esc 7-3, 08036, Barcelona, Spain

    Vicente Arroyo

  2. Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain

    Javier Fernandez

Authors
  1. Vicente Arroyo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Javier Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vicente Arroyo .

Editor information

Editors and Affiliations

  1. Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA

    Andrew P. Keaveny

  2. Institut de Malalties Digestives i Metaboliques, University of Barcelona, Barcelona, Spain

    Andrés Cárdenas

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Arroyo, V., Fernandez, J. (2015). Acute-on-Chronic Liver Failure. In: Keaveny, A., Cárdenas, A. (eds) Complications of Cirrhosis. Springer, Cham. https://doi.org/10.1007/978-3-319-13614-1_25

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-13614-1_25

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13613-4

  • Online ISBN: 978-3-319-13614-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation