Narrative Reviews
Acute-on-Chronic Liver Failure
Image: Shutterstock / Noppadon Seesuwan
General
General
- Karvellas. Management of the acute on chronic liver failure in the intensive care unit. Liver Int. 2025;45(3):e15659.
- Allhoff. Acute-on-Chronic Liver Failure—Current Management and Future Perspectives. Biomedicines. 2025;13(9):2193.
- Trebicka. Acute-on-Chronic Liver Failure. Dtsch Arztebl Int 2025;122(4):96-102
- Karvellas. Management of the acute on chronic liver failure in the intensive care unit. Liver Int 2025;45(3):e15659
- Goran. Acute-on-Chronic Liver Failure: Steps Towards Consensus. Diagnostics 2025;15(6):751
- Haider. From Critical Care to Transplant: Enhancing Outcomes in Acute-on-Chronic Liver Failure. Curr Hepatology Rep 2025;24:9
Prognostication
Definitions
- Xu. Acute-on-chronic liver failure: From definition to pathogenesis and therapy. Chin Med J. 2026;139(8):1110-1124.
- Kadayifci. Acute-on-chronic liver failure: from definitions to management. Ann Palliat Med. 2026;15(1):10.
- Goran. Acute-on-Chronic Liver Failure: Steps Towards Consensus. Diagnostics. 2025;15(6):751.
- Hernaez. Definition, diagnosis and epidemiology of acute-on-chronic liver failure. Liver Int. 2025;45(3):e15670.
Background
Pathophysiology
- Knop-Chodyła. Acute-on-Chronic Liver Failure: An Eroded Cliff Hit by a Storm—A Narrative Review. Int J Mol Sci. 2026;27(14):6414.
- Pohl. Role of Intestinal Barrier Disruption to Acute-on-Chronic Liver Failure. Semin Liver Dis. 2025;45(1):52-65.
- Jagdish. Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failure. Front Med 2023;10:1060073
- Schierwagen. Pathogenetic mechanisms and therapeutic approaches of acute-to-chronic liver failure. Am J Physiol Cell Physiol 2023;325(1):C129-C140
Immunology
- Mukherjee. Neutrophil immunometabolism in ACLF and sepsis: mechanisms, dysfunction, and therapeutic opportunities. Front Immunol. 2026;17:1828801.
- Ortega-Ribera. Uncovering immune dysfunction in ACLF: Cellular mechanisms, molecular pathways, and therapeutic frontiers. J Hepatol. 2026;epublished April 29th.
- Engelmann. Mechanisms of immunity in acutely decompensated cirrhosis and acute-on-chronic liver failure. Liver Int. 2025;45(3):e15644.
- Li. Immunological Mechanisms and Effects of Bacterial Infections in Acute-on-Chronic Liver Failure. Cells 2025;14(10):718
- Engelmann. Mechanisms of immunity in acutely decompensated cirrhosis and acute-on-chronic liver failure. Liver Int 2025;45(3):e15644
Metabolism
- Zhang. Metabolic Dysregulation and Metabolite Imbalances in Acute-on-chronic Liver Failure: Impact on Immune Status. J Clin Transl Hepatol 2024;12(10):865-877
- Clària. Roles of systemic inflammatory and metabolic responses in the pathophysiology of acute-on-chronic liver failure. JHEP Rep 2023;5(9):100807
Conditions
Cirrhosis
- McCoy. Acute and non-acute decompensation of liver cirrhosis. Liver Int. 2025;45(3):e15861.
- Valainathan. Prognosis algorithms for acute decompensation of cirrhosis and acute-on-chronic liver failure. Liver Int. 2025;45(3):e15927.
- Xu. Acute decompensation of cirrhosis versus acute-on-chronic liver failure: What are the clinical implications? United European Gastroenterol J 2024;12(2):194-202
Complications
Acute Kidney Injury
Hyperammonaemia
Sepsis
Organ Failure
Sepsis
Monitoring & Investigations
General
Scoring Systems
Therapies
General
Extracorporeal Support
Renal Replacement Therapy
Liver Transplantation
- L’Hermite. Liver transplantation in the context of acute-on-chronic liver failure (ACLF): where do we stand in 2025?. Transpl Int 2025;38:14752
- Kulkarni. Liver transplantation for acute liver failure and acute-on-chronic liver failure. Am J Transplant 2024;24(11):1950-1962
- Choudhury. Liver Transplantation in Chronic Liver Disease and Acute on Chronic Liver Failure- Indication, Timing and Practices. J Clin Exp Hepatol 2024;14(3):101347
- Sacleux. How to Optimize the Results of Liver Transplantation for Acute-on-Chronic Liver Failure. Life (Basel) 2023;13(5):1152
Last updated August 13th, 2026