UMEM Educational Pearls

Category: Critical Care

Title: Acute-On-Chronic Liver Failure

Posted: 12/19/2023 by Mike Winters, MD (Updated: 4/22/2024)
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Acute-On-Chronic Liver Failure

  • Acute-on-chronic liver failure (ACLF) is defined as an acute deterioration of liver function in a patient with cirrhosis that is associated with organ failure and has high short-term mortality.
  • Key extrahepatic organ failures in ACLF include the renal, CNS, respiratory, circulatory, and coagulation systems.
  • With respect to CNS failure in ACLF:
    • Hepatic encephalopathy (HE) is the most common manifestation
    • A normal ammonia level makes HE unlikely
    • Benzodiazepines should be avoided
    • Primary triggers for HE include infection, GIB, and aggressive diuresis
    • Treatment of HE primarily consists of lactulose and rifaximin

References

Perricone G, et al. Intensive care management of acute-on-chronic liver failure. Critical Care. 2023;49:903-21.