The Asian Pacific Association for the study of the liver (APASL) reported a definition for acute-on-chronic liver failure (ACLF).


Definition for acute-on-chronic liver failure:

(1) an acute hepatic insult

(2) initial development of jaundice and coagulopathy

(3) followed by ascites and/or encephalopathy within 4 weeks

(4) presence of chronic liver disease, either diagnosed or undiagnosed


Causes of the acute hepatic injury may include:

(1) reactivation of hepatitis B or C

(2) hepatotropic or nonhepatotropic viruses

(3) other infectious agents affecting the liver

(4) alcohol

(5) hepatotoxic drug or chemical

(6) flare of autoimmune hepatitis

(7) flare of Wilson’s disease

(8) surgery or trauma

(9) variceal bleed


The clinical picture is affected by how severe the acute hepatitis and chronic hepatitis are.


Differential diagnosis:

(1) acute liver injury de novo

(2) progression of the chronic liver disease


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