Acute-on-chronic liver failure in East Asia: an underestimated issue with limited data

Mezzano et al reported that in a meta-analysis of 30 selected cohort studies in which acute-on-chronic liver failure (ACLF) was defined using the European Association for the Study of the Liver-Chronic Liver Failure Consortium (EASL-CLIF-C) criteria, the global prevalence of ACLF was estimated to be 35%, being lowest in East Asia (15%).1 This reported prevalence in East Asia was unexpectedly low, contradicting our clinical observations in this region. Several concerns arise when interpreting the results of this study. First, there were overlaps in the two cohorts from China …