Acute-on-chronic liver failure in cirrhosis: Defining and managing organ dysfunction

The term 'acute-on-chronic liver failure' was first used in the 1960s mainly in relation to flares of viral hepatitis. It was not until the turn of the millennium, however, that the term entered the everyday vocabulary of hepatologists when it was used to describe the pathophysiological deterioration in patients with cirrhosis mainly in the context of trials utilizing liver support devices [1]. Since then, a consensus definition of acute-on-chronic liver failure has been fiercely debated. The terms 'compensated' and 'decompensated' liver disease are rarely used in the critical care arena with patients being defined with regard to the degree of organ dysfunction rather than by quantifying liver synthetic function per se. Moreover, it has been shown that the prognosis in patients with cirrhosis is strongly correlated with the number of failing organs [2-4] and that certain cohorts of patients with severe hepatic encephalopathy, acute variceal bleeding, and organ failure benefit from admission to a critical care environment [5]. © 2009 Springer-Verlag New York.