Defining Acute on Chronic Liver Failure: More Elusive Than Ever

Abstract

The onset of jaundice, ascites, hepatic encephalopathy and variceal bleeding has traditionally been termed "decompensated cirrhosis", which is associated with high mortality without liver transplantation. Decompensated cirrhosis is deemed to be distinct from "acute‐on‐chronic liver failure" (ACLF), a condition in which chronic liver disease patients with/without cirrhosis have a rapid decline characterized by hepatic and extra‐hepatic organ failures, usually after a precipitating event(1). ACLF is associated with higher mortality and expenditure than decompensated cirrhosis. There are at least 10 different definitions of ACLF(2); yet what makes ACLF unique has not been characterized. Despite this, the number of citations of ACLF increased from 2 in year 2000 to 2485 in 2018.

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