A valuable update on ACLF (Acute on chronic liver failure) by V Arroyo, R Moreau and R Jalan in the prestigious review NEJM

Acute-on-chronic liver failure (ACLF) is a severe complication of cirrhosis. It has a very bad prognosis and is characterized by an intense systemic inflammation associated with single- or multiple-organ failure. Defined in 2013 by Richard Moreau as a clinical entity occurring in cirrhotic patients with acute decompensation, it remains however difficult to diagnose, some people doubting even its existence. This review was thus particularly expected for those who have interest in chronic liver diseases. It revisits the definition of ACLF, identifies the main elements involved in its pathophysiology and lists the potential therapeutic arsenal available, depending on precipitating events and organ failure. No doubt that this review will serve as a benchmark from now on.

 

Source : V Arroyo, R Moreau, R Jalan. Acute-on-chronic liver failure, New England J Medicine 2020 ; 382 : 2137-45.