Acute-on-chronic liver failure: Pathogenesis, prognostic factors and management

Core Tip

Core tip: Acute on-chronic liver failure is a newly recognized syndrome characterized by acute deterioration of a compensated or decompensated chronic liver disease, leading to organ failure, and a mortality rate ≥ 15% at 28-d. Pathogenesis involves an exaggerated systemic inflammatory response in the setting of immune dysregulation and oxidative stress. Alcohol is a frequent precipitating factor seen most commonly in the West, and untreated hepatitis B virus infection is more prevalently seen in the East. However, it must be noted, that specific precipitant factors cannot be established in up to the 40% of cases. Recent prospective work has generated data on definition, prevalence, precipitating factors and scoring systems. Treatment of precipitant factors, complications, organ failure support, and liver transplantation are the current therapeutic options.