Acute-on-Chronic Liver Failure in intensive care unit

The concept of Acute-on-Chronic Liver Failure (ACLF) syndrome is defined as an acute condition occurring on a chronic hepatic disease, and includes a pro-inflammatory reaction and the presence of at least one organ failure. This syndrome is associated with a high short-term mortality (28-days mortality following hospital admission) ranging from 20-25 % in the presence of one organ failure to more than 75 % with more than two organ failures. The CLIF-SOFA criteria are used to define the organ failures encountered in an ACLF (haemodynamic, respiratory, hepatic, coagulation, renal and neurological criteria). Cirrhotic patients who develop an ACLF are classified as followed : grade 1, 2, or 3 according to whether one, two, or three or more organ failures are present, respectively. Twenty-six per cent of in-hospital cirrhotic patients acquire an ACLF. Among them, 8 % occur during their hospitalisation. To date, there is no specific treatment for ACLF. The main goal of treating cirrhotic patients with ACLF is to support organ failure while managing the cause and triggering factors. In the most severe forms, this management should be considered as a bridge to liver transplantation. Liver transplantation is the ultimate effective treatment as it is the only curative treatment of cirrhosis. The place of liver transplantation has recently evolved and should be considered in all patients with a severe form of ACLF (at least one organ failure). The main objective is to prevent the development of ACLF in high-risk patients and to limit the progression towards a multi-organ failure.