ICU · gi-nutrition

Acute-on-Chronic Liver Failure (ACLF) — Comprehensive ICU Management

Also known as ACLF · Acute-on-chronic liver failure · Acute decompensation of cirrhosis with organ failure · CLIF-C ACLF score · CANONIC criteria · Cirrhosis ICU

Acute-on-chronic liver failure (ACLF) — acute decompensation of cirrhosis complicated by organ failure(s) and high short-term mortality. In the CANONIC study, 28-day mortality was 33.9 percent in patients who had ACLF at enrolment versus 1.9 percent in those who never developed it, and grade of ACLF (number of organ failures) drives prognosis: with four or more organ failures and no transplant, 28-day mortality was 100 percent (CLIF cohort). Precipitants: bacterial infection (the most frequent associated factor) and severe alcohol-related hepatitis, identified or occult (EASL CPG 2023). Management: treat the precipitant, support failing organs, reverse hepatorenal-spectrum AKI with terlipressin plus albumin, give albumin 1.5 g per kg then 1 g per kg with antibiotics in spontaneous bacterial peritonitis, feed protein 1 to 1.5 g per kg per day rather than restricting it, and consider early liver transplantation — 1-year post-transplant survival 81 percent even in listed ACLF (ECLIS).

Checked against its sources on 8 Oct 2026