Clinical Classification of Liver Failure: Consensus, Contradictions and New Recommendations

Liver failure (LF) is a clinical syndrome with complex clinical manifestations. The clinical diagnosis and classification of LF are still considerably different internationally. Based on the pace of the disease progression and its possible reversibility, LF can be divided into two categories: acute and chronic LF. However, a great difference exists in the diagnostic criteria between China, Europe, and the United States. These differences might be related to the various causes of LF, the complexity of clinical manifestations, and different experiences of experts from different centers. The main source of differences lies in the varied understanding of LF diagnostic standards. The pathologic basis of various types of LF is different also. This article discusses the clinical diagnosis and classification of LF internationally and suggests new recommendations for classification of LF. According to this classification, ALF is divided into fulminant type and subacute type, and CLF is divided into acute exacerbative type and slowly progressive type. This classification, if adopted worldwide, could help achieve uniformity in the classification and therapeutic guidelines for liver failure. However, the validity of the classification should be further tested in clinical practice.