Frontiers in Medicine,
Journal Year:
2024,
Volume and Issue:
11
Published: May 17, 2024
Background
Elevated
international
normalized
ratio
of
prothrombin
time
(PT-INR)
is
one
the
key
characteristics
acute-on-chronic
liver
failure
(ACLF).
Whether
staging
PT-INR
has
ability
to
screen
out
subgroups
ACLF
patients
who
would
be
more
eligible
for
artificial
support
system
(ALSS)
treatment
not
been
studied
in
detail.
Methods
A
previous
study
enrolled
receiving
ALSS
with
regional
citrate
anticoagulation
from
January
2018
December
2019.
Patients
different
intervals
were
retrospectively
enrolled:
1.3
≤
<
1.5
(Pre-stage),
2.0
(Early-stage),
2.5
(Mid-stage),
and
≥
(End-stage).
The
Cox
proportional
hazards
models
used
estimate
association
between
stages
or
sessions
90
day
mortality.
Results
total
301
enrolled.
mortality
risk
Early-stage
(adjusted
hazard
(aHR)
(95%
confidence
interval
(CI)),
3.20
(1.15–8.89),
p
=
0.026),
Mid-stage
(3.68
(1.34–10.12),
0.011),
End-stage
(12.74
(4.52–35.91),
0.001)
higher
than
that
Pre-stage
patients,
respectively.
was
similar
(1.15
(0.69–1.94),
0.591).
an
independent
protective
factor
(aHR
CI),
0.81
(0.73–0.90),
0.001).
received
3–5
lower
1–2
0.34
(0.20–0.60),
0.001),
whereas
≥6
(0.69
(0.43–1.11),
0.128).
Conclusion
Pre-,
Early-,
Mid-stages
might
treatment.
Application
reasonable.
Hepatology International,
Journal Year:
2019,
Volume and Issue:
13(4), P. 353 - 390
Published: June 6, 2019
The
first
consensus
report
of
the
working
party
Asian
Pacific
Association
for
Study
Liver
(APASL)
set
up
in
2004
on
acute-on-chronic
liver
failure
(ACLF)
was
published
2009.
With
international
groups
volunteering
to
join,
"APASL
ACLF
Research
Consortium
(AARC)"
formed
2012,
which
continued
collect
prospective
patient
data.
Based
data
analysis
nearly
1400
patients,
AARC
2014.
In
past
four-and-a-half
years,
database
has
been
enriched
about
5200
cases
by
major
hepatology
centers
across
Asia.
during
interim
period
were
carefully
analyzed
and
areas
contention
new
developments
field
prioritized
a
systematic
manner.
also
approached
answering
some
issues
where
limited,
such
as
grading,
its
impact
'Golden
Therapeutic
Window',
extrahepatic
organ
dysfunction
failure,
development
sepsis,
distinctive
features
acute
decompensation
from
pediatric
analyzed.
These
initiatives
concluded
two-day
meeting
October
2018
at
New
Delhi
with
finalization
consensus.
Only
those
statements,
based
evidence
using
Grade
System
unanimously
recommended,
accepted.
Finalized
statements
again
circulated
all
experts
subsequently
presented
investigators
AASLD
November
2018.
suggestions
used
revise
finalize
After
detailed
deliberations
analysis,
original
definition
found
withstand
test
time
be
able
identify
homogenous
group
patients
presenting
failure.
management
options
including
algorithms
coagulation
disorders,
renal
replacement
therapy,
variceal
bleed,
antivirals
criteria
transplantation
proposed.
final
along
relevant
background
information
requiring
future
studies
are
here.
The American Journal of Gastroenterology,
Journal Year:
2022,
Volume and Issue:
unknown
Published: Jan. 10, 2022
In
patients
with
cirrhosis
and
chronic
liver
disease,
acute-on-chronic
failure
is
emerging
as
a
major
cause
of
mortality.
These
guidelines
indicate
the
preferred
approach
to
management
represent
official
practice
recommendations
American
College
Gastroenterology.
The
scientific
evidence
for
these
was
evaluated
using
Grading
Recommendations,
Assessment,
Development,
Evaluation
process.
instances
where
not
appropriate
Evaluation,
but
there
consensus
significant
clinical
merit,
key
concept
statements
were
developed
expert
consensus.
are
meant
be
broadly
applicable
should
viewed
preferred,
only,
scenarios.
Clinical and Molecular Hepatology,
Journal Year:
2023,
Volume and Issue:
29(3), P. 670 - 689
Published: March 20, 2023
Acute-on-chronic
liver
failure
is
an
acute
deterioration
of
function
manifesting
as
jaundice
and
coagulopathy
with
the
development
ascites,
a
high
probability
extrahepatic
organ
involvement
28-day
mortality.
The
pathogenesis
involves
extensive
hepatic
necrosis,
which
associated
severe
systemic
inflammation
subsequently
causes
cytokine
storm,
leading
to
portal
hypertension,
dysfunction,
failure.
These
patients
have
increased
gut
permeability,
releasing
lipopolysaccharide
(LPS)
damage-associated
molecular
patterns
(DAMPS)
in
blood,
hyper-immune
activation
secretion
cytokines,
followed
by
immune
paralysis,
causing
infections
proportion
patients.
Early
detection
institution
treatment,
especially
"Golden
Window"
period
7
days,
gives
opportunity
for
reversal
syndrome.
Scores
like
Asian
Pacific
Association
Study
Liver
(APASL)
ACLF
research
consortium
(AARC)
score,
model
end
stage
disease
(MELD),
CLIF
Consortium
acute-on-chronic
(CLIF-C
ACLF)
score
can
help
prediction
Treatment
strategy
includes
treatment
insult.
Patients
should
be
considered
early
transplant
MELD
>28,
AARC
>10,
high-grade
encephalopathy,
absence
>2
or
overt
sepsis
improve
survival
up
80%
at
five
years.
Patients,
no
option
transplant,
treated
emerging
therapies
faecal
microbial
plasma
exchange,
etc.,
need
further
evaluation.
Hepatology International,
Journal Year:
2025,
Volume and Issue:
19(1), P. 1 - 69
Published: Feb. 1, 2025
Acute-on-chronic
liver
failure
(ACLF)
is
a
condition
associated
with
high
mortality
in
the
absence
of
transplantation.
There
have
been
various
definitions
proposed
worldwide.
The
first
consensus
report
working
party
Asian
Pacific
Association
for
Study
Liver
(APASL)
set
2004
on
ACLF
was
published
2009,
and
"APASL
Research
Consortium
(AARC)"
formed
2012.
AARC
database
has
prospectively
collected
nearly
10,500
cases
from
countries
Asia-Pacific
region.
This
instrumental
developing
score
grade
ACLF,
concept
'Golden
Therapeutic
Window',
'transplant
window',
plasmapheresis
as
treatment
modality.
Also,
data
key
to
identifying
pediatric
ACLF.
European
Liver-Chronic
Failure
(EASL
CLIF)
North
American
End
Stage
Disease
(NACSELD)
West
added
concepts
organ
infection
precipitants
development
CLIF-Sequential
Organ
Assessment
(SOFA)
NACSELD
scores
prognostication.
Chinese
Group
Severe
Hepatitis
B
(COSSH)
COSSH-ACLF
criteria
manage
hepatitis
b
virus-ACLF
without
cirrhosis.
literature
supports
these
be
equally
effective
their
respective
cohorts
patients
mortality.
To
overcome
differences
develop
global
consensus,
APASL
took
initiative
invited
stakeholders,
including
opinion
leaders
Asia,
EASL
AASLD,
other
researchers
field
identify
issues
an
evidence-based
document.
document
presented
hybrid
format
at
annual
meeting
Kyoto
March
2024.
'Kyoto
Consensus'
below
carries
final
recommendations
along
relevant
background
information
areas
requiring
future
studies.
Hepatology,
Journal Year:
2018,
Volume and Issue:
69(1), P. 258 - 269
Published: Aug. 6, 2018
Lactate
levels
and
lactate
clearance
are
known
predictors
of
outcome
in
critically
ill
patients
the
intensive
care
unit
(ICU).
The
prognostic
value
is
not
well
established
liver
cirrhosis
acute-on-chronic
failure
(ACLF).
aim
this
study
was
to
assess
with
cirrhosis.
Patients
admitted
ICU
were
studied
at
University
Medical
Center
Hamburg-Eppendorf
(n
=
566,
derivation
cohort)
Vienna
Hospitals
Leuven
250,
validation
cohort).
Arterial
measured
on
admission
during
first
24
hours.
followed
for
1
year
assessed.
Admission
directly
related
number
organs
failing
28-day
mortality
(area
under
receiver
operating
characteristic
[AUROC]
0.72;
P
<
0.001).
This
also
applied
follow-up
measurements
after
6,
12,
hours
(P
0.001
all,
AUROC
>
0.70
all).
had
significant
predictive
ability
elevated
serum
≥5
mmol/L.
12-hour
(in
mmol/L),
respectively,
identified
as
1-year
mortality,
independent
Chronic
Liver
Failure
Consortium
score
(CLIF-C
ACLFs).
A
lactate-adjusted
CLIF-C
ACLFs
developed
ACLFsLact
),
which
performed
significantly
better
than
original
prediction
cohort.
Conclusion:
appropriately
reflect
severity
disease
organ
independently
associated
short-term
a
simple
but
accurate
marker,
its
incorporation
improved
performance
significantly.
Liver Transplantation,
Journal Year:
2019,
Volume and Issue:
26(1), P. 127 - 140
Published: Nov. 19, 2019
Liver
transplantation
(LT)
for
alcohol
associated
hepatitis
(AH)
remains
controversial.
We
convened
a
consensus
conference
to
examine
various
aspects
of
LT
AH.
The
goal
was
not
unequivocally
endorse
AH;
instead,
it
propose
recommendations
programs
that
perform
or
plan
Criteria
were
established
determine
candidacy
in
the
setting
AH
and
included
following:
(1)
patients
presenting
first
time
with
decompensated
liver
disease
are
nonresponders
medical
therapy
without
severe
psychiatric
comorbidities;
(2)
fixed
period
abstinence
prior
is
required;
(3)
assessment
multidisciplinary
psychosocial
team,
including
social
worker
an
addiction
specialist/mental
health
professional
expertise.
Supporting
factors
lack
repeated
unsuccessful
attempts
at
rehabilitation,
other
substance
use/dependency,
acceptance
diagnosis/insight
commitment
patient/family
sobriety,
formalized
agreement
adhere
total
counseling.
should
be
avoided
who
likely
spontaneously
recover.
Short‐term
longterm
survival
comparable
indications
must
achieved.
There
further
disparity
either
by
indication,
geography,
sociodemographic
factors.
Treatment
alcohol‐use
disorders
incorporated
into
pre‐
post‐LT
care.
restrictive
focused
evaluation
process
described
initial
experience
worldwide
may
endure
as
this
indication
gains
wider
more
programs.
Transparency
selection
crucial
requires
collection
objective
data
assess
outcomes
minimize
center
variation
listing.
Oversight
program
adherence
important
harmonize
listing
practices
outcomes.
Hepatology,
Journal Year:
2022,
Volume and Issue:
unknown
Published: Sept. 24, 2022
Schilsky,
Michael
L.;
Roberts,
Eve
A.;
Bronstein,
Jeff
M.;
Dhawan,
Anil;
Hamilton,
James
P.;
Rivard,
Anne
Marie;
Washington,
Mary
Kay;
Weiss,
Karl
Heinz;
Zimbrean,
Paula
C.
Author
Information