Clinical case: acute on chronic liver failure (ACLF)

Abstract

Acute-on-chronic liver failure (AcLF) is an acute liver disorder manifested as jaundice (serum bilirubin levels ≥5 mg/dL) and coagulopathy (Inr ≥1.5 or prothrombin activity < 40%), complicated by ascites and/or encephalopathy within 4 weeks, that is found in patients with the previously diagnosed or undiagnosed chronic liver disease. AcLF is a serious medical issue worldwide. The AcLF pathogenesis is based on the pronounced systemic inflammatory response to pathogenic antigens and biological structures produced during the liver cell death, with subsequent immune paralysis and multiple organ failure. Acute-on-chronic liver failure (AcLF) may develop at any stage, from compensated to decompensated cir- rhosis; the disorder may involve both hepatic and extrahepatic precipitating events. drug treatment of AcLF includes early detection and treat-ment of the precipitating factor and maintenance therapy. It has been proven that treatment of the trigger at an early stage reduces mortality,however, the management of AcLF is focused mostly on the maintenance therapy. AcLF belongs to the syndromes seldom diagnosed in clinical practice, that is why the AcLF case study is of special interest. The paper reports a confirmed case of AcLF.

Keywords

• hepatic cirrhosis
• acute-on-chronic liver failure
• jaundice
• portal hypertension
• ascites
• coagulopathy