Acute-on-Chronic Liver Failure_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHAOYong-heng ,  ZHOUWen-jie , CHENGang , HUZong-qiang

Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Kunming City and Affiliated Ganmei Hospital of Kunming Medical University, Kunming 650011, Yunnan Province, China;

Corresponding author：

ZHAOYong-heng, Email: Zyh1115@yahoo.com; zhouerpi@163.com; 49181812@qq.com

Keywords：

Liver failure; Liver cirrhosis; Hepatic B virus; Pathophysiology

DOI：

10.7507/1007-9424.20150332

Video：

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Objective To retrospective analysis the research progress of the acute-on-chronic liver failure (ACLF), and provide some useful advice for the early diagnosis, evaluation, and treatments of ACLF. Methods The literatures on ACLF which published in domestic and overseas for these years were reviewed. Results ACLF, which is an acute deterioration of liver function results from precipitating events in patients with chronic liver disease. As an independent clinical entity and different from acute liver failure (ALF), sub-acute liver failure (SALF), and chronic liver failure (CLF). For the high short-term mortality and seldom good treatment measures, attached much people's attention. Conclusion The research of ACLF makes great advance but still exits different in some field between the East and the West. Search dangerous etiology earlier, combine with reality and early effective treatments can develop total survival rate of ACLF.

Citation： ZHAOYong-heng, ZHOUWen-jie, CHENGang, HUZong-qiang. Acute-on-Chronic Liver Failure. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(10): 1274-1278. doi: 10.7507/1007-9424.20150332 Copy

1.	Ohnishi H, Sugihara J, Moriwaki H, et al. Actue-on-chronic liver failure. Ryoikibetsu Shokogun Shirizu, 1995, 7:217-219.
2.	Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology, 2013, 144(7):1426-1437.
3.	Jalan R, Williams R. Acute-on-chronic liver failure:pathophysiological basis of therapeutic options. Blood Purif, 2002, 20(3):252-261.
4.	Olson JC, Kamath PS. Acute-on-chronic liver failure:concept, natural history, and prognosis. Curr Opin Crit Care, 2011, 17(2):165-169.
5.	Moreau R, Jalan R, Arroyo V. Acute-on-chronic liver failure:recent concepts. J Clin Exp Hepatol, 2015, 5(1):81-85.
6.	Sarin SK, Kumar A, Almeida JA, et al. Actue-on-chrnic liver failure:consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int, 2009, 3(1):269-282.
7.	刘晓燕, 陈婧, 王晓霞, 等. 3233例急性、亚急性、慢加急性肝衰竭病因特点分析.临床医学工程, 2012, 19(5):823-825.
8.	中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊疗指南.中华肝脏病杂志, 2006, 14(9):643-646.
9.	中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2012年版).中华临床感染病杂志, 2012, 5(6):321-327.
10.	Wlodzimirow KA, Eslami S, Abu-Hanna A, et al. A systematic review on prognostic indicators of acute on chronic liverfailure and their predictive value for mortality. Liver Int, 2013, 33(1):40-52.
11.	Verbeke L, Nevens F, Laleman W. Bench-to-beside review:acuteon-chronic liver failure-linking the gut, liver and systemic circulation. Crit Care, 2011, 15(5):233-244.
12.	刘青, 王泰龄.慢加急性肝衰竭(ACLF)共识纪要:亚太肝病学会推荐(APASL).临床肝胆病杂志, 2010, 26(1):13-18.
13.	张爱民, 王慧芬, 李桂英, 等. HBV突变与HBV相关慢加急性肝衰竭相关性研究.传染病信息, 2014, 27(2):74-81.
14.	Duseja A, Chawla YK, Dhiman RK, et al. Non-hepatic insults are common acute precipitants in patients with acute on chronic liver failure (ACLF). Dig Dis Sci, 2010, 55(11):3188-3192.
15.	Kim TY, Kim DJ. Acute-on-chronic liver failure. Cli Mol Hepatol, 2013, 19(4):349-359.
16.	Graziadei IW. The clinical challenges of acute on chronic liver failure. Liver Int, 2011, 31(Suppl 3):24-26.
17.	Olson JC, Kamath PS. Acute-on-chronic liver failure:what are the implications? Curr Gastroenterol Rep, 2012, 14(1):63-66.
18.	Ambrosino G, Naso A, Feltracco P, et al. Cytokines and liver failure:modification of TNF-αand IL-6 in patients with acute on chronic liver decompensation treated with Molecular Adsorbent Recycling System (MARS). Acta Biomed, 2003, 74 Suppl 2:7-9.
19.	Wasmuth HE, Kunz D, Yagmur E, et al. Patients with acute on chronic liver failure display "sepsis-like" immune paralysis. J Hepatol, 2005, 42(2):195-201.
20.	Yang J, Yi P, Wei L, et al. Phenotypes and clinical significance of circulating CD4⁺ CD25+ regulatory T cells (Tregs) in patients with acute-on-chronic liver failure (ACLF). J Transl Med, 2012, 15(10):193-205.
21.	Zhang JY, Zhang Z, Lin F, et al. Interleukin-17-producing CD4⁺ T cells increase with severity of liver damage in patients with chronic hepatitis B. Hepatology, 2010, 51(1):81-91.
22.	Jalan R, Stadlbauer V, Sen S, et al. Natural history of acute decompensation of cirrhosis:the basis of definition, prognosis and pathophysiology of acute on chronic liver failure. Hepatology, 2006, 44(1):371A-372A.
23.	Angeli P, Rodríguez E, Piano S, et al. Acute kidney injury and acuteon-chronic liver failure classifications in prognosis assessment of patients with acute decompensation of cirrhosis. Gut, 2014, Oct 13, [Epub ahead of print].
24.	Wan ZH, Wang JJ, You SL, et al. Cystatin C is a biomarker for predicting acute kidney injury in patients with acute-on-chronic liver failure. World J Gastroenterol, 2013, 19(48):9432-9438.
25.	Chen J, Yang Q, Huang J, et al. Risk factors for invasive pulmonary aspergillosis and hospital mortality in acute-on-chronic liver failure patients:a retrospective-cohort study. Int J Med Sci, 2013, 10(12):1625-1631.
26.	Rastogi A, Bihari C, Maiwall R, et al. Hepatic stellate cells are involved in the pathogenesis of acute-on-chronic liver failure (ACLF). Virchows Arch, 2012, 461(4):393-398.
27.	Garg H, Kumar A, Garga V, et al. Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure. Dig Liver Dis, 2012, 44(2):166-171.
28.	Biggins SW, Kim WR, Terrault NA, et al. Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology, 2006, 130(6):1652-1660.
29.	高国生, 朱海超.四种评分系统对乙型肝炎慢加急性肝衰竭的短期预后评价.中国急救医学, 2010, 30(11):979-982.
30.	Duseja A, Choudhary NS, Gupta S, et al. APACHEⅡscore is superior to SOFA, CTP and MELD in predicting the short-term mortality in patients with acute-on-chronic liver failure (ACLF). J Dig Dis, 2013, 14(9):484-490.
31.	Cholongitas E, Senzolo M, Patch D, et al. Risk factors, sequential organ failure assessment and model for end-stage liver disease scores for predicting short term mortality in cirrhotic patients admitted to intensive care unit. Aliment Pharmacol Ther, 2006, 23(7):883-893.
32.	Dhiman RK, Jain S, Maheshwari U, et al. Early indicators of prognosis in fulminant hepatic failure:an assessment of the Model for End-Stage Liver Disease (MELD) and King's College Hospital criteria. Liver Transpl, 2007, 13(6):814-821.
33.	Zheng MH, Shi KQ, Fan YC, et al. A model to determine 3-month mortality risk in patients with acute-on-chronic hepatitis B liver failure. Clin Gastroenterol Hepatol, 2011, 9(4):351-356.
34.	张绍全, 雷姿颖, 陈俊峰, 等.短程地塞米松不能提高乙型肝炎慢加急性肝衰竭生存率.中山大学学报:医学科学版, 2014, 35(1):67-73.
35.	Miyake Y, Iwasaki Y, Takaki A, et al. Lamivudine treatment improves the prognosis of fulminant hepatitis B. Intern M ed, 2008, 47(14):1293-1299.
36.	Goyal R, Kumar A, Panda SK, et al. Ribavirin therapy for hepatitis E virus-induced acute on chronic liver failure:a preliminary report. Antivir Ther, 2012, 17(6):1091-1096.
37.	段钟平, 陈煜.人工肝技术进展.传染病学信息, 2007, 20(3):129-131.
38.	Pareja E, Cortes M, Bonora A, et al. New alternatives to the treatment of acute liver failure. Transplant Proc, 2010, 42(8):2959-2961.
39.	翁伟镇, 陈俊峰, 梅咏予, 等.异体骨髓问充质干细胞治疗不同时相慢加急性乙肝肝衰竭患者的疗效.中山大学学报:医学科学版, 2013, 34(3):422-427.
40.	Xu X, Liu X, Ling Q, et al. Artificial liver support system combined with liver transplantation in the treatment of patients with acuteon-chronic liver failure. PLoS One, 2013, 8(3):e58738.
41.	胡启江, 江应安.拉米夫定联合血浆置换治疗乙型肝炎相关慢加急性肝衰竭的疗效分析.临床肝胆病杂志, 2013, 29(2):107-109.

1. Ohnishi H, Sugihara J, Moriwaki H, et al. Actue-on-chronic liver failure. Ryoikibetsu Shokogun Shirizu, 1995, 7:217-219.
2. Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology, 2013, 144(7):1426-1437.
3. Jalan R, Williams R. Acute-on-chronic liver failure:pathophysiological basis of therapeutic options. Blood Purif, 2002, 20(3):252-261.
4. Olson JC, Kamath PS. Acute-on-chronic liver failure:concept, natural history, and prognosis. Curr Opin Crit Care, 2011, 17(2):165-169.
5. Moreau R, Jalan R, Arroyo V. Acute-on-chronic liver failure:recent concepts. J Clin Exp Hepatol, 2015, 5(1):81-85.
6. Sarin SK, Kumar A, Almeida JA, et al. Actue-on-chrnic liver failure:consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int, 2009, 3(1):269-282.
7. 刘晓燕, 陈婧, 王晓霞, 等. 3233例急性、亚急性、慢加急性肝衰竭病因特点分析.临床医学工程, 2012, 19(5):823-825.
8. 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊疗指南.中华肝脏病杂志, 2006, 14(9):643-646.
9. 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2012年版).中华临床感染病杂志, 2012, 5(6):321-327.
10. Wlodzimirow KA, Eslami S, Abu-Hanna A, et al. A systematic review on prognostic indicators of acute on chronic liverfailure and their predictive value for mortality. Liver Int, 2013, 33(1):40-52.
11. Verbeke L, Nevens F, Laleman W. Bench-to-beside review:acuteon-chronic liver failure-linking the gut, liver and systemic circulation. Crit Care, 2011, 15(5):233-244.
12. 刘青, 王泰龄.慢加急性肝衰竭(ACLF)共识纪要:亚太肝病学会推荐(APASL).临床肝胆病杂志, 2010, 26(1):13-18.
13. 张爱民, 王慧芬, 李桂英, 等. HBV突变与HBV相关慢加急性肝衰竭相关性研究.传染病信息, 2014, 27(2):74-81.
14. Duseja A, Chawla YK, Dhiman RK, et al. Non-hepatic insults are common acute precipitants in patients with acute on chronic liver failure (ACLF). Dig Dis Sci, 2010, 55(11):3188-3192.
15. Kim TY, Kim DJ. Acute-on-chronic liver failure. Cli Mol Hepatol, 2013, 19(4):349-359.
16. Graziadei IW. The clinical challenges of acute on chronic liver failure. Liver Int, 2011, 31(Suppl 3):24-26.
17. Olson JC, Kamath PS. Acute-on-chronic liver failure:what are the implications? Curr Gastroenterol Rep, 2012, 14(1):63-66.
18. Ambrosino G, Naso A, Feltracco P, et al. Cytokines and liver failure:modification of TNF-αand IL-6 in patients with acute on chronic liver decompensation treated with Molecular Adsorbent Recycling System (MARS). Acta Biomed, 2003, 74 Suppl 2:7-9.
19. Wasmuth HE, Kunz D, Yagmur E, et al. Patients with acute on chronic liver failure display "sepsis-like" immune paralysis. J Hepatol, 2005, 42(2):195-201.
20. Yang J, Yi P, Wei L, et al. Phenotypes and clinical significance of circulating CD4⁺ CD25+ regulatory T cells (Tregs) in patients with acute-on-chronic liver failure (ACLF). J Transl Med, 2012, 15(10):193-205.
21. Zhang JY, Zhang Z, Lin F, et al. Interleukin-17-producing CD4⁺ T cells increase with severity of liver damage in patients with chronic hepatitis B. Hepatology, 2010, 51(1):81-91.
22. Jalan R, Stadlbauer V, Sen S, et al. Natural history of acute decompensation of cirrhosis:the basis of definition, prognosis and pathophysiology of acute on chronic liver failure. Hepatology, 2006, 44(1):371A-372A.
23. Angeli P, Rodríguez E, Piano S, et al. Acute kidney injury and acuteon-chronic liver failure classifications in prognosis assessment of patients with acute decompensation of cirrhosis. Gut, 2014, Oct 13, [Epub ahead of print].
24. Wan ZH, Wang JJ, You SL, et al. Cystatin C is a biomarker for predicting acute kidney injury in patients with acute-on-chronic liver failure. World J Gastroenterol, 2013, 19(48):9432-9438.
25. Chen J, Yang Q, Huang J, et al. Risk factors for invasive pulmonary aspergillosis and hospital mortality in acute-on-chronic liver failure patients:a retrospective-cohort study. Int J Med Sci, 2013, 10(12):1625-1631.
26. Rastogi A, Bihari C, Maiwall R, et al. Hepatic stellate cells are involved in the pathogenesis of acute-on-chronic liver failure (ACLF). Virchows Arch, 2012, 461(4):393-398.
27. Garg H, Kumar A, Garga V, et al. Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure. Dig Liver Dis, 2012, 44(2):166-171.
28. Biggins SW, Kim WR, Terrault NA, et al. Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology, 2006, 130(6):1652-1660.
29. 高国生, 朱海超.四种评分系统对乙型肝炎慢加急性肝衰竭的短期预后评价.中国急救医学, 2010, 30(11):979-982.
30. Duseja A, Choudhary NS, Gupta S, et al. APACHEⅡscore is superior to SOFA, CTP and MELD in predicting the short-term mortality in patients with acute-on-chronic liver failure (ACLF). J Dig Dis, 2013, 14(9):484-490.
31. Cholongitas E, Senzolo M, Patch D, et al. Risk factors, sequential organ failure assessment and model for end-stage liver disease scores for predicting short term mortality in cirrhotic patients admitted to intensive care unit. Aliment Pharmacol Ther, 2006, 23(7):883-893.
32. Dhiman RK, Jain S, Maheshwari U, et al. Early indicators of prognosis in fulminant hepatic failure:an assessment of the Model for End-Stage Liver Disease (MELD) and King's College Hospital criteria. Liver Transpl, 2007, 13(6):814-821.
33. Zheng MH, Shi KQ, Fan YC, et al. A model to determine 3-month mortality risk in patients with acute-on-chronic hepatitis B liver failure. Clin Gastroenterol Hepatol, 2011, 9(4):351-356.
34. 张绍全, 雷姿颖, 陈俊峰, 等.短程地塞米松不能提高乙型肝炎慢加急性肝衰竭生存率.中山大学学报:医学科学版, 2014, 35(1):67-73.
35. Miyake Y, Iwasaki Y, Takaki A, et al. Lamivudine treatment improves the prognosis of fulminant hepatitis B. Intern M ed, 2008, 47(14):1293-1299.
36. Goyal R, Kumar A, Panda SK, et al. Ribavirin therapy for hepatitis E virus-induced acute on chronic liver failure:a preliminary report. Antivir Ther, 2012, 17(6):1091-1096.
37. 段钟平, 陈煜.人工肝技术进展.传染病学信息, 2007, 20(3):129-131.
38. Pareja E, Cortes M, Bonora A, et al. New alternatives to the treatment of acute liver failure. Transplant Proc, 2010, 42(8):2959-2961.
39. 翁伟镇, 陈俊峰, 梅咏予, 等.异体骨髓问充质干细胞治疗不同时相慢加急性乙肝肝衰竭患者的疗效.中山大学学报:医学科学版, 2013, 34(3):422-427.
40. Xu X, Liu X, Ling Q, et al. Artificial liver support system combined with liver transplantation in the treatment of patients with acuteon-chronic liver failure. PLoS One, 2013, 8(3):e58738.
41. 胡启江, 江应安.拉米夫定联合血浆置换治疗乙型肝炎相关慢加急性肝衰竭的疗效分析.临床肝胆病杂志, 2013, 29(2):107-109.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Acute-on-Chronic Liver Failure

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