Table Info

Table 1.

Interguideline differences in ACLF definition

Characteristics	APASL	EASL-CLIF	NACSELD
Definition	Acute jaundice and coagulopathy, followed by ascites ± HE within 4 weeks	Specified criteria using CLIF-OF score for OF, 28-day mortality rate > 15%	≥ 2 extrahepatic OF (circulation, kidney, cerebral, respiratory)
Organ failure	AARC score	CLIF-C OF score	MELD score
Liver	T. Bil ≥ 5 mg/dL + INR ≥ 1.5	T. Bil ≥ 12 mg/dL	-
Kidney	AKI Network criteria	Cr ≥ 2 or RRT	RRT
Cerebral	HE 3–4	HE 3–4	HE 3–4
Coagulopathy	-	INR ≥ 2.5	-
Circulatory	-	Need to use of vasopressor (terlipressin and/or catecholamines)	Shock (MAP < 60 mmHg or > 40 mmHg systolic BP reduction from baseline)
Respiratory	-	PaO₂/FiO₂ ≤ 200 or sPO₂/FiO₂ ≤ 214 or need for mechanical ventilation (≤ 300 for ALI or ≤ 200 for ARDS)	Need for mechanical ventilation
Inclusion criteria	Undiagnosed or diagnosed chronic liver disease, including cirrhosis	Cirrhosis ± prior decompensation	Inpatient cirrhosis (± prior decompensation) with infection at or during admission
Exclusion criteria	Prior decompansation Bacterial infection GI bleeding HCC	HCC with beyond Milan criteria Receiving immunosuppressive treatment HIV Severe chronic extrahepatic disease	Outpatients with infection Cirrhosis without infection HIV Prior organ transplantation Disseminated malignancies
Time frame	4 weeks	4–12 weeks	Not defined
Major organ failure	Hepatic	Hepatic + extrahepatic	Extrahepatic
Time of diagnosis	Early	Moderate	Too late

AARC: APASL-ACLF research consortium; ACLF: acute-on-chronic liver failure; AKI: acute kidney injury; ALI: acute lung injury; APASL: Asian Pacific Association for the Study of the Liver; ARDS: adult respiratory distress syndrome; Cr: creatinine; EASL-CLIF: European Association for the Study of the Liver-Chronic Liver Failure; FiO₂: fraction of inspired oxygen; GI: gastrointestinal; HCC: hepatocelluler carcinoma; HE: hepatic encephalopathy (West-Haven criteria); HIV: human immunodeficiency virus; INR: international normalized ratio; MAP: mean arterial pressure; MELD: Model of the End Liver Disease; NACSELD: North American Consortium for the Study of End-Stage Liver Disease; OF: organ failure; PaO₂: partial pressure of arterial oxygen; RRT: renal replacement therapy; BP: blood pressure; sPO₂: pulse oximetric saturation; T.Bil: total bilirubin

Declarations

Author contributions

SA: Conceptualization, Investigation, Writing—review & editing.

Conflicts of interest

The author declares no conflicts of interest.

Ethical approval

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