Simple organ failure count versus  CANONIC grading system for predicting mortality in acute-on-chronic liver failure

2015 ◽  
Vol 30 (3) ◽  
pp. 575-581 ◽  
Author(s):  
Swastik Agrawal ◽  
Ajay Duseja ◽  
Tarana Gupta ◽  
Radha K Dhiman ◽  
Yogesh Chawla
Keyword(s):  
Liver Failure ◽  
Organ Failure ◽  
Chronic Liver ◽  
Grading System ◽  
Chronic Liver Failure

Inflammasome and extrahepatic organ failure in acute-on-chronic liver failure

2017 ◽  
Vol 1 ◽  
pp. 34-34
Author(s):  
Carmen Sendra ◽  
Javier Ampuero ◽  
Manuel Romero-Gómez
Keyword(s):  
Liver Failure ◽  
Organ Failure ◽  
Chronic Liver ◽  
Chronic Liver Failure

Liver failure

2020 ◽  
pp. 3089-3100
Author(s):  
Jane Macnaughtan ◽  
Rajiv Jalan
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Hepatic Encephalopathy ◽  
Liver Injury ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Organ Failure ◽  
Clinical Manifestations ◽  
Chronic Liver ◽  
Chronic Liver Failure

Liver failure occurs when loss of hepatic parenchymal function exceeds the capacity of hepatocytes to regenerate or repair liver injury. Acute liver failure is characterized by jaundice and prolongation of the prothrombin time in the context of recent acute liver injury, with hepatic encephalopathy occurring within 8 weeks of the first onset of liver disease. Acute-on-chronic liver failure is characterized by hepatic and/or extrahepatic organ failure in patients with cirrhosis associated with an identified or unidentified precipitating event. The commonest causes of acute liver failure are acute viral hepatitis and drugs. Acute-on-chronic liver failure is most commonly precipitated by infection, alcohol abuse, and superimposed viral infection. The main clinical manifestations are hepatic encephalopathy, coagulopathy, jaundice, renal dysfunction, and haemodynamic instability. Infection and systemic inflammation contribute to pathogenesis and critically contribute to prognosis. Specific therapy for the underlying liver disease is administered when available, but this is not possible for most causes of liver failure. Treatment is predominantly supportive, with particular emphasis on (1) correction or removal of precipitating factors; (2) if encephalopathy is present, using phosphate enemata, nonhydrolysed disaccharide laxatives, and/or rifaximin; (3) early detection and prompt treatment of complications such as hypoglycaemia, hypokalaemia, cerebral oedema, infection, and bleeding. The onset of organ failure should prompt discussion with a liver transplantation centre. The mortality of acute liver failure (without liver transplantation) is about 40%. Patients with acute liver failure who do not develop encephalopathy can be expected to recover completely. Those who recover from an episode of acute-on-chronic liver failure should be considered for liver transplantation because otherwise their subsequent mortality remains high.

Acute-on-chronic liver failure: to admit to intensive care or not?

2020 ◽  
Vol 81 (9) ◽  
pp. 1-6
Author(s):  
Asif Arshad ◽  
Lylah Irshad ◽  
Theodore Nabavi ◽  
Tony Whitehouse
Keyword(s):  
Liver Failure ◽  
Organ Failure ◽  
Gastrointestinal Haemorrhage ◽  
Chronic Liver ◽  
Organ Support ◽  
Chronic Liver Failure ◽  
Short Term Mortality ◽  
Organ Failures ◽  
Clinical Scoring ◽  
Excessive Alcohol

Acute-on-chronic liver failure is used to describe an acute decline in liver function in a patient with existing liver disease combined with other organ failure. Acute-on-chronic liver failure is associated with high short-term mortality, and the greater the number and severity of organ failures, the higher the mortality. The most commonly identified precipitants of acute-on-chronic liver failure include bacterial infection, gastrointestinal haemorrhage, viral hepatitis and recent excessive alcohol intake. Since some of these aetiologies are treatable, organ failure may return to pre-decompensation levels in up to 55% of patients. As a result, a trial of critical care treatment may be appropriate for many of these patients. Clinical scoring tools may help clinicians recognise futility, allowing timely withdrawal of organ support and shifting the focus of care toward palliation.

scholarly journals Acute-on-chronic liver failure: definition, prognosis and management

2019 ◽  
Vol 11 (6) ◽  
pp. 458-467
Author(s):  
Ahmed Amin ◽  
Rajeshwar P Mookerjee
Keyword(s):  
Liver Transplantation ◽  
Liver Failure ◽  
Organ Failure ◽  
Limited Resource ◽  
Chronic Liver ◽  
Rapid Progression ◽  
Organ Shortage ◽  
Chronic Liver Failure ◽  
Hepatic Decompensation ◽  
Short Term Mortality

Acute-on-chronic liver failure (ACLF) is a recently described entity in chronic liver disease defined by acute hepatic decompensation, organ failure and a high risk of short-term mortality (usually less than 4 weeks). This condition is distinct from acute liver failure and stable progression of cirrhosis in numerous ways, including triggering precipitant factors, systemic inflammation, rapid progression and a potential for recovery. While a clear definition of ACLF has been forwarded from a large European Consortium study, some heterogeneity remains in how patients present and the types of organ failure, depending on whether they are described in Asian or European studies. Active alcoholism, acute alcoholic hepatitis and infections are the most frequent precipitants for ACLF. Underpinning the pathophysiology of ACLF is a state of persistent inflammation and immune dysfunction, collectively driving a systematic inflammatory response syndrome and an increased propensity to sepsis. Prevention and early treatment of organ failure are key in influencing survival. Given increasing organ shortage and more marginal grafts, liver transplantation is a limited resource and emphasises the need for new therapies to improve ACLF outcomes. Recent data indicate that liver transplantation has encouraging outcomes even in patients with advanced ACLF if patients are carefully selected during the permissive window of clinical presentation. ACLF remains a significant challenge in the field of hepatology, with considerable research and resource being channelled to improve upon the definition, prognostication, treatment and unravelling of mechanistic drivers. This Review discusses updates in ACLF definition, prognosis and management.

Serum cholinesterase, an underestimated marker in the prediction of acute-on-chronic liver failure, organ failure and LTx-free survival in patients with liver cirrhosis?

2020 ◽  
Vol 73 ◽  
pp. S504
Author(s):  
Tammo Lambert Tergast ◽  
Abdul-Rahman Kabbani ◽  
Marie Schultalbers ◽  
Michael P. Manns ◽  
Markus Cornberg ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Failure ◽  
Organ Failure ◽  
Chronic Liver ◽  
Serum Cholinesterase ◽  
Chronic Liver Failure ◽  
Free Survival

Acute on chronic liver failure because of acute hepatic insults: Etiologies, course, extrahepatic organ failure and predictors of mortality

2016 ◽  
Vol 31 (4) ◽  
pp. 856-864 ◽  
Author(s):  
Shalimar ◽  
Dharmendra Kumar ◽  
Padmaprakash Kadavoor Vadiraja ◽  
Baibaswata Nayak ◽  
Bhaskar Thakur ◽  
...  
Keyword(s):  
Liver Failure ◽  
Organ Failure ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Predictors Of Mortality

Sa1019 Validation of a Definition and Grading System for Acute on Chronic Liver Failure

2012 ◽  
Vol 142 (5) ◽  
pp. S-948
Author(s):  
Harjit K. Bhogal ◽  
Apollo K. Musana ◽  
Kevin R. Ward ◽  
Vimal K. Mishra ◽  
R. Todd Stravitz ◽  
...  
Keyword(s):  
Liver Failure ◽  
Chronic Liver ◽  
Grading System ◽  
Chronic Liver Failure
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