Critical care hepatology: A narrative review of current concepts and management

Table 1 Indications for intensive care admission in critically ill patients with liver-driven disease

Clinical context	Definition	Indications for ICU level care
Acute decompensation of cirrhosis	Acute worsening of cirrhosis (ascites, HE, bleeding, infection) without established extrahepatic organ failure, primarily driven by portal hypertension	Impaired consciousness requiring airway protection (HE grade III-IV or active bleeding); severe infection requiring hemodynamic monitoring; acute variceal bleeding requiring endoscopic or radiologic intervention (including rescue TIPS), particularly with instability; early signs of deterioration with risk of progression to ACLF
ACLF	Acute decompensation with ≥ 1 organ failure and high short-term mortality	Requirement for advanced organ support (vasopressors, renal replacement therapy, invasive ventilation); failure of ward-based management; ACLF grade ≥ 2; evolving multiorgan dysfunction; persistent hyperlactatemia or worsening shock despite resuscitation
ALF	Acute liver injury with coagulopathy and HE in a previously non-cirrhotic liver	Any degree of encephalopathy due to risk of cerebral edema; significant coagulopathy (e.g., INR > 2); rapidly evolving biochemical failure; need for early transplant assessment and neurocritical monitoring
Non-hepatic or peri-procedural indications in liver disease	Patients with liver disease admitted for non-hepatic illness or post-intervention monitoring	Post-procedural observation (e.g., TIPS, interventional radiology); postoperative care after non-hepatic surgery; acute cardiovascular or neurological events; need for intensified monitoring due to limited physiological reserve in cirrhosis

Summary of key clinical scenarios and indications for intensive care admission in patients with acute and chronic liver failure, reflecting the need for timely escalation of organ support and transplant evaluation. ICU: Intensive care unit; HE: Hepatic encephalopathy; TIPS: Transjugular intrahepatic portosystemic shunt; ACLF: Acute-on-chronic liver failure; ALF: Acute liver failure; INR: International normalized ratio.