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Review

Challenges in Diagnosis and Therapeutic Approach of Acute on Chronic Liver Failure—A Review of Current Evidence

by
Cristina Maria Marginean
1,†,
Denisa  Pirscoveanu
2,†,
Mihaela Popescu
3,†,
Corina Maria Vasile
4,†,
Anca Oana Docea
5,*,
Radu Mitruț
6,
Iulia Cristina Mărginean
7,
George Alexandru Iacob
7,
Dan Mihai Firu
8 and
Paul Mitruț
1
1
Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
2
Department of Neurology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
3
Department of Endocrinology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
4
Department of Pediatric Cardiology, “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
5
Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
6
Department of Cardiology, University and Emergency Hospital, 050098 Bucharest, Romania
7
Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
8
Ph.D. School Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work, thus sharing the first authorship.
Biomedicines 2023, 11(7), 1840; https://doi.org/10.3390/biomedicines11071840
Submission received: 29 May 2023 / Revised: 23 June 2023 / Accepted: 25 June 2023 / Published: 26 June 2023
(This article belongs to the Special Issue Chronic Kidney and Liver Disease: From Pathophysiology to Novel Therapeutic Approaches 2.0)
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Abstract

Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute and severe decompensation of chronic liver disease (CLD) correlated with multiple organ failure, poor prognosis, and increased mortality. In 40–50% of ACLF cases, the trigger is not recognized; for many of these patients, bacterial translocation associated with systemic inflammation is thought to be the determining factor; in the other 50% of patients, sepsis, alcohol consumption, and reactivation of chronic viral hepatitis are the most frequently described trigger factors. Other conditions considered precipitating factors are less common, including acute alcoholic hepatitis, major surgery, TIPS insertion, or inadequate paracentesis without albumin substitution. Host response is likely the primary factor predicting ACLF severity and prognosis, the host immune response having a particular significance in this syndrome, together with the inflammatory cascade. The management of ACLF includes both the prevention of the precipitating factors that lead to acute liver decompensation and the support of vital functions, the prevention and management of complications, the estimation of prognosis, and the opportunity for liver transplantation.
Keywords: acute-on-chronic liver failure; liver cirrhosis; gut microbiome; liver transplantation; organ failure acute-on-chronic liver failure; liver cirrhosis; gut microbiome; liver transplantation; organ failure

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MDPI and ACS Style

Marginean, C.M.; Pirscoveanu, D.; Popescu, M.; Vasile, C.M.; Docea, A.O.; Mitruț, R.; Mărginean, I.C.; Iacob, G.A.; Firu, D.M.; Mitruț, P. Challenges in Diagnosis and Therapeutic Approach of Acute on Chronic Liver Failure—A Review of Current Evidence. Biomedicines 2023, 11, 1840. https://doi.org/10.3390/biomedicines11071840

AMA Style

Marginean CM, Pirscoveanu D, Popescu M, Vasile CM, Docea AO, Mitruț R, Mărginean IC, Iacob GA, Firu DM, Mitruț P. Challenges in Diagnosis and Therapeutic Approach of Acute on Chronic Liver Failure—A Review of Current Evidence. Biomedicines. 2023; 11(7):1840. https://doi.org/10.3390/biomedicines11071840

Chicago/Turabian Style

Marginean, Cristina Maria, Denisa  Pirscoveanu, Mihaela Popescu, Corina Maria Vasile, Anca Oana Docea, Radu Mitruț, Iulia Cristina Mărginean, George Alexandru Iacob, Dan Mihai Firu, and Paul Mitruț. 2023. "Challenges in Diagnosis and Therapeutic Approach of Acute on Chronic Liver Failure—A Review of Current Evidence" Biomedicines 11, no. 7: 1840. https://doi.org/10.3390/biomedicines11071840

APA Style

Marginean, C. M., Pirscoveanu, D., Popescu, M., Vasile, C. M., Docea, A. O., Mitruț, R., Mărginean, I. C., Iacob, G. A., Firu, D. M., & Mitruț, P. (2023). Challenges in Diagnosis and Therapeutic Approach of Acute on Chronic Liver Failure—A Review of Current Evidence. Biomedicines, 11(7), 1840. https://doi.org/10.3390/biomedicines11071840

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