Challenges in Diagnosis and Therapeutic Approach of Acute on Chronic Liver Failure—A Review of Current Evidence

Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute and severe decompensation of chronic disease (CLD) correlated with multiple organ failure, poor prognosis, increased mortality. In 40–50% ACLF cases, the trigger not recognized; for many these patients, bacterial translocation associated systemic inflammation thought to be determining factor; in other 50% sepsis, alcohol consumption, reactivation viral hepatitis are most frequently described factors. Other conditions considered precipitating factors less common, including alcoholic hepatitis, major surgery, TIPS insertion, or inadequate paracentesis without albumin substitution. Host response likely primary factor predicting severity host immune having particular significance this syndrome, together inflammatory cascade. The management includes both prevention that lead support vital functions, complications, estimation opportunity transplantation.