Proposal for the classification of acute-on-chronic liver failure (ACLF) types Ⅰ and Ⅱ. (IMAGE)
Caption
Patients with chronic liver diseases (alcoholic liver disease (ALD), chronic hepatitis B (CHB), autoimmune hepatitis (AIH), metabolic associated fatty liver disease (MAFLD), inherited metabolic liver diseases (IMLD), or unknown) due to various causes experience acute insults, such as excessive alcohol intake, hepatitis B virus reactivation, drug-induced liver injury, autoimmune disease flare-ups, or infections, leading to a rapid deterioration in liver function. Based on the characteristics of intra-hepatic and extra-hepatic organ failure at the onset, the proposition that ACLF could be classified into two clinical types was first put forward by the China Network for Severe Liver Diseases (CNSLD). The definition of type Ⅰ ACLF (liver failure without extra-hepatic organ failures) is close to the content of the APASL and the CMA, which emphasizes that liver failure is the primary manifestation without extra-hepatic organ failures, mainly manifesting as jaundice and coagulation dysfunction, and some patients have hepatic encephalopathy. The definition of type Ⅱ ACLF (liver failure with extra-hepatic organ failures) is close to the content of COSSH, EASL-CLIF, and NACSELD, which manifests as elevated total bilirubin (TBIL), prolonged PT-INR, and the occurrence of cirrhosis complications, accompanied by liver and at least one extra-hepatic organ failure within one week. During the progression of ACLF, the two clinical types can be mutually transformed according to the advancement or improvement of the condition.
Credit
Chinese Medical Journal
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