Overview on acute-on-chronic liver failure

Abstract

Liver failure (LF) is defined as severe dysfunction in hepatic synthesis, detoxification, and metabolism induced by various etiologies. Clinical presentation of LF typically includes severe jaundice, coagulation disorder, hepatic encephalopathy, and ascites. LF can be classified into acute LF, acute-on-chronic LF (ACLF), and chronic LF. ACLF has been demonstrated as a distinct syndrome with unique clinical presentation and outcomes. The severity, curability, and reversibility of ACLF have attracted considerable attention. Remarkable developments in ACLF-related conception, diagnostic criteria, pathogenesis, and therapy have been achieved. However, this disease, especially its diagnostic criteria, remains controversial. In this paper, we systemically reviewed the current understanding of ACLF from its definition, etiology, pathophysiology, pathology, and clinical presentation to management by thoroughly comparing important findings between east and west countries, as well as those from other regions. We also discussed the controversies, challenges, and needs for future studies to promote the standardization and optimization of the diagnosis and treatment for ACLF.

Keywords

liver failure / chronic liver failure / acute-on-chronic liver failure / diagnosis / prognosis / treatment

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Acknowledgements

This work was supported by the National Science and Technology Major Project (No. 2016ZX10002008-04; PI: Zhongping Duan), the National Science and Technology Major Project (No. 2016ZX 10004906-014; PI: Jing Zhang), Beijing Municipal Science and Technology Project (No. Z141100002114022; PI: Jing Zhang), the Municipal Laboratory for Liver Protection and Regulation of Regeneration Project (No. 2014GZBH01; PI: Jing Zhang), and Science and Technology Project of Beijing Municipal Education Commission (No. KM20130025008; PI: Wenfang Wu).

Compliance with ethics guidelines

Jing Zhang, Shan Gao, Zhongping Duan, and Ke-Qin Hu declare that they have no conflict of interest. This manuscript is a review article and does not involve a research protocol requiring approval by the relevant institutional review board or ethics committee.

RIGHTS & PERMISSIONS

2016 Higher Education Press and Springer-Verlag Berlin Heidelberg