Three common acute-on-chronic liver failure definitions

DefinitionThe European Association for the Study of the Liver-Chronic Liver Failure Consortium (EASL-CLIF)Asian Pacific Association for the Study of the Liver (APASL)North American Consortium for the Study of End-Stage Liver Disease (NACSELD)
Criteria
  • Presence of acutely decompensated cirrhosis [12]

  • Patient experiences hepatic and extrahepatic organ failures assessed by CLIF-SOFA score [13]

  • CLIF-SOFA score is used to confirm organ failure by investigating the function of the brain, kidney, liver, coagulation, circulation, and respiration [12]

  • Manifestations of acute hepatic decompensation include coagulopathy, hepatic encephalopathy, ascites, gastrointestinal (GI) hemorrhage, and bacterial infections [13]

  • High short-term mortality rate [13]

  • Patient with chronic liver disease or cirrhosis (identified or unidentified) [13]

  • Acute hepatic injury evident by jaundice and coagulopathy, the presence of ascites and/or hepatic encephalopathy within a month [13]

  • No extrahepatic organ failures/dysfunction considered [18]

  • Events considered acute insults if they cause acute liver decompensation events such as jaundice, ascites or hepatic encephalopathy, and coagulopathy [12, 18]

  • High 28-day mortality rate [13]

  • 2 or more extrahepatic organ failures including grade III and IV hepatic encephalopathy, mechanical ventilation, renal replacement therapy, and shock [13]

  • Presence of acutely decompensated cirrhosis [12]

CLIF-SOFA: Chronic Liver Failure Consortium-Sequential Organ Failure Assessment