Exploration of Digestive Diseases

From: Acute decompensation and acute-on-chronic liver failure

Table 4. Treatment strategies in both acute decompensation (AD) and acute-on-chronic liver failure (ACLF)

Characteristics	Treatment
Underlying cause and acute triggering factors	Cause-specific treatment
Infection	Antibacterial, antiviral, antifungal
Coagulopathy	LMWH, DOACs, warfarin, platelet replacement, cryoprecipitate, FFP, 4-FPCC
Renal Failure	Fluid resuscitation, withdraw diuretics, albumin, vasoconstrictors, RRT
Hepatic encephalopathy	Lactulose/polyethylene glycol, L-ornithine L-aspartate/ornithine phenylacetate, rifaximin^, albumin^
Cardiovascular failure	Fluid resuscitation, albumin, vasopressors (norepinephrine, vasopressin), hydrocortisone
Respiratory failure	Pulmonary vasodilators (inhaled NO, epoprostenol), NIV, high-flow oxygen, MV
Sarcopenia	Nutrition
Liver failure	Liver transplantation
Bridge treatments	Plasma exchange, single-pass albumin dialysis, MARS, Prometheus
Next generation treatments	G-CSF, MSC transplantation, TLR-4 inhibition, TAK-242, recombinant alkaline phosphatase, gDNA, emricasan, mitofusin-2, oxysterol sulfates, statin, NAC

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^* The roles of these treatments are unclear. DOACs: direct-acting anticoagulants; FFP: fresh frozen plasma; 4-FPCC: four-factor prothrombin complex concentrate; G-CSF: granulocyte colony stimulating factor; LMWH: low molecule weighed heparin; MARS: the molecular adsorbent recirculation system; MSC: mesenchymal stem cell; MV: mechanical ventilation; NAC: N-acetylcysteine; NIV: non-invasive ventilation; NO: nitric oxide; RRT: renal replacement therapy; TLR-4: Toll-like receptor 4

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Author contributions

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

Conflicts of interest

The author declares no conflicts of interest.

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