Acute-on-chronic liver failure (ACLF) is defined as an acute deterioration of liver function in a patient with cirrhosis that is associated with organ failure and has high short-term mortality.
Key extrahepatic organ failures in ACLF include the renal, CNS, respiratory, circulatory, and coagulation systems.
With respect to CNS failure in ACLF:
Hepatic encephalopathy (HE) is the most common manifestation
A normal ammonia level makes HE unlikely
Benzodiazepines should be avoided
Primary triggers for HE include infection, GIB, and aggressive diuresis
Treatment of HE primarily consists of lactulose and rifaximin
References
Perricone G, et al. Intensive care management of acute-on-chronic liver failure. Critical Care. 2023;49:903-21.
