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Definition of ACLF and inclusion criteria for extra-hepatic organ failure

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Abstract

A prominent characteristic of ACLF is rapid hepatic disease progression with subsequent extra-hepatic organ failure, manifesting as either hepatic coma or hepatorenal syndrome, which is associated with a high mortality rate in a short time. The APASL definition mainly emphasizes recognizing patients with hepatic failure. These patients may subsequently develop extra-hepatic multisystem organ failure leading to high mortality. It is therefore worthwhile to identify the short interim period between the development of liver failure and the onset of extra-hepatic organ failure, the potential therapeutic ‘golden window.’ Interventions during this period may prevent the development of complications and eventually change the course of the illness. Organ failure is suggested to be a central component of ACLF and may behave differently from chronic decompensated liver disease. Clear and practical criteria for the inclusion of organ failure are urgently needed so that patients with these life-threatening complications can be treated in a timely and appropriate manner. Recent studies suggested that the scoring systems evaluating organ failure [acute physiology, age and chronic health evaluation (APACHE) and sequential organ failure assessment (SOFA) scores] work better than those addressing the severity of liver disease [Child-Pugh and model of end-stage liver disease (MELD) scores] in ACLF. However, a key problem remains that the former scoring systems are reflective of organ failure and not predictive, thus limiting their value as an early indication for intervention.

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Compliance with ethical requirements and Conflict of interest

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study. Xiaojing Wang, Shiv Kumar Sarin and Qin Ning declare that they have no conflict of interest.

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Authors and Affiliations

  1. Institute and Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Xiaojing Wang & Qin Ning

  2. Department of Gastroenterology, Institute of Liver and Biliary Sciences, G B Pant Hospital, University of Delhi, New Delhi, India

    Shiv Kumar Sarin

Authors
  1. Xiaojing Wang
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  2. Shiv Kumar Sarin
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  3. Qin Ning
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Correspondence to Qin Ning.

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On behalf of the ACLF working party APASL.

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Wang, X., Sarin, S.K. & Ning, Q. Definition of ACLF and inclusion criteria for extra-hepatic organ failure. Hepatol Int 9, 360–365 (2015). https://doi.org/10.1007/s12072-015-9637-x

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