Alcohol and Acute-on-Chronic Liver Failure

Autores de INCLIVA

• Maria Pilar Ballester Ferre

  Autor

Participantes ajenos a INCLIVA

• Sittner, R
• Jalan, R

Grupos y Plataformas de I+D+i

• Grupo de Investigación de Deterioro Neurológico

  

  Leading Researcher

  María Del Carmen Montoliu Félix

Abstract

Acute-on-chronic liver failure (ACLF) is a clinical syndrome that occurs in patients with cirrhosis and is char-acterised by acute deterioration, organ failure and high short-term mortality. Alcohol is one of the leading causes of ACLF and the most frequently reported aetiology of underlying chronic liver disease. Among pa-tients with alcoholic hepatitis (AH), ACLF is a frequent and severe complication. It is characterised by both immune dysfunction associated to an increased risk of infection and high-grade systemic inflammation that ultimately induce organ failure. Diagnosis and severity of ACLF determine AH prognosis, and therefore, ACLF prognostic scores should be used in severe AH with organ failure. Corticosteroids remain the first-line treatment for severe AH but they seem insufficient when ACLF is associated. Novel therapeutic targets to contain the excessive inflammatory response and reduce infection have been identified and are under investi-gation. With liver transplantation remaining one of the most effective therapies for severe AH and ACLF, adequate organ allocation represents a growing challenge. Hence, a clear understanding of the pathophysi-ology, clinical implications and management strategies of ACLF in AH is essential for hepatologists, which is narrated briefly in this review. ( J CLIN EXP HEPATOL 2022;12:1360-1370)

© 2021 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.

Keywords

• acute -on -chronic liver failure; alcoholic hepatitis; cirrhosis