Triggering factors in AD and ACLF

Triggering factorsADACLF
Unknown57%10–50%
KnownInfections (58%)Infections (48%)
HBV reactivationHBV reactivation
HAV infectionHAV infection
HEV infectionHEV infection
Alcohol-related hepatitisAlcohol-related hepatitis
DILIDILI
Neurotoxic drugsNeurotoxic drugs
GI bleedingGI bleeding*
SurgeryNative American ancestry
Trauma
TIPS
TACE
RFA
Portal vein thrombosis

* Gastrointestinal (GI) bleeding is not accepting a trigger factor for ACLF in APASL unless it fulfills the APASL-ACLF criteria and causes jaundice and coagulopathy. AD: acute decompensation; ACLF: acute-on-chronic liver failure; DILI: drug-induced liver injury; RFA: radiofrequency ablation; TACE: transarterial chemoembolization; TIPS: transjugular intrahepatic portosystemic shunt