Definitions of Acute-On-Chronic Liver Failure: The Past, the Present, and the Future

*Roland Amathieu,1 Ali Al-Khafaji2

1. Department of Critical Care Medicine and Anesthesiology, AP-HP, Henri Mondor Hospital,  School of Medicine, Université Paris Est Créteil, Créteil, France
2. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, and  University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
*Correspondence to

Disclosure: No potential conflict of interest.
Received: 21.11.14 Accepted: 11.12.14
Citation: EMJ Hepatol. 2015;3[1]:35-40.


Acute-on-chronic liver failure (ACLF) is an entity used to define patients with liver cirrhosis presenting with acute decompensation. For over 20 years, ACLF has taken multiple definitions and/or  classifications. Unfortunately, to date, there has not been a universally accepted definition/classification  of this entity. In this short review, we discuss the definition evolution of ACLF, the strengths and  weaknesses of the existing definitions and classifications, and finally the potential role of the ‘omic’ approaches for the diagnosis of this complex syndrome.

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