Acute-on-chronic liver failure (ACLF) is a condition occurring with 4-12 weeks of jaundice and/or an inciting event in cirrhosis resulting in hepatic decompensation.
ACLF is distinct from acute liver failure and decompensated cirrhosis. Extra-hepatic organ failure is a late event in ACLF.
Diagnostic tests for ACLF are Liver biopsy, endoscopy and hepatic venous-pressure gradient (HVPG).
An AARC score above 10 predicts poor prognosis; in cases with no SIRS/sepsis, emergency transplant should be recommended.
If AARC sore is 4-7 and is improving, medical treatment should be suggested; in the case of no improvement of an increasing score, emergency transplant should be recommended.
If EH organ failure >4 and plasmapheresis reveals amyotrophic lateral sclerosis (ALS) which is improving, then supportive care should be given; otherwise, an emergency transplant should be advised.
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