Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2015; 21(42): 12125-12140
Published online Nov 14, 2015. doi: 10.3748/wjg.v21.i42.12125
Acute-on-chronic liver failure: Pathogenesis, prognostic factors and management
Sara Blasco-Algora, José Masegosa-Ataz, María Luisa Gutiérrez-García, Sonia Alonso-López, Conrado M Fernández-Rodríguez
Sara Blasco-Algora, José Masegosa-Ataz, María Luisa Gutiérrez-García, Sonia Alonso-López, Conrado M Fernández-Rodríguez, Service of Gastroenterology, Hospital Universitario Fundación, 28922 Alcorcón, Madrid, Spain
Author contributions: Blasco-Algora S, Masegosa-Ataz J, Gutiérrez-García ML, Alonso-López S and Fernández-Rodríguez CM contributed to the study idea, study design, literature search, manuscript writing and final revision of the article.
Conflict-of-interest statement: The authors declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Conrado M Fernandez-Rodriguez, MD, Service of Gastroenterology, Hospital Universitario Fundación, Alcorcón, Av Budapest-1, 28922 Alcorcón, Madrid, Spain.
Telephone: +34-91-6219513 Fax: +34-91-6219975
Received: June 28, 2015
Peer-review started: July 1, 2015
First decision: July 20, 2015
Revised: August 17, 2015
Accepted: September 30, 2015
Article in press: September 30, 2015
Published online: November 14, 2015
Core Tip

Core tip: Acute on-chronic liver failure is a newly recognized syndrome characterized by acute deterioration of a compensated or decompensated chronic liver disease, leading to organ failure, and a mortality rate ≥ 15% at 28-d. Pathogenesis involves an exaggerated systemic inflammatory response in the setting of immune dysregulation and oxidative stress. Alcohol is a frequent precipitating factor seen most commonly in the West, and untreated hepatitis B virus infection is more prevalently seen in the East. However, it must be noted, that specific precipitant factors cannot be established in up to the 40% of cases. Recent prospective work has generated data on definition, prevalence, precipitating factors and scoring systems. Treatment of precipitant factors, complications, organ failure support, and liver transplantation are the current therapeutic options.