ICU · GI/Nutrition

Acute-on-chronic liver failure (ACLF)

Also known as Acute-on-chronic liver failure (ACLF) · CLIF-C score · APASL ACLF · Liver transplant for ACLF · CANONIC criteria · CLIF-C OF score · Cirrhosis with organ failure

ACLF is acute decompensation of known cirrhosis with organ failure(s), exaggerated systemic inflammation, and high 28-day mortality — distinct from simple decompensation. Precipitants: bacterial infection first (none identified in about 40 percent), alcohol-associated hepatitis, GI bleed, drugs, viral hepatitis. CLIF-C OF grades six organ domains; CLIF-C ACLF adds age and white count and is recalculated at 48 hours. Without transplant, 28-day mortality runs about 18 to 25 percent in grade 1 and 68 to 89 percent in grade 3; transplant in selected grade 2 to 3 patients raises 6-month survival from about 10 to about 80 percent. Treatment: manage the precipitant, organ support, terlipressin plus albumin for HRS-AKI (CONFIRM), albumin 1.5 g per kg then 1 g per kg for SBP (Sort), prednisolone only for severe alcohol-associated hepatitis with day-7 Lille reassessment, no INR correction before procedures, no protein restriction.

Checked against its sources on 8 Oct 2026