Acute decompensation of liver cirrhosis and acute-on-chronic liver failure: diagnostic and prognostic criteria, treatment strategy

Annotation. In recent years, new data have been obtained regarding the course of liver cirrhosis (LC) and ways of its decompensation. Acute-on-chronic liver failure (ACLF) is a newly identified separate clinical syndrome that develops in 30% of patients with acute LC decompensation, characterized by hepatic and extrahepatic organ failure and high short-term mortality. The aim of this review was to describe the clinical and prognostic value of acute LC decompensation and ACLF, the pathophysiological mechanisms of their development, and existing diagnostic and treatment approaches. A search in the PubMed database using the keywords "liver cirrhosis, acute decompensation of cirrhosis, acute-on-chronic liver failure" allowed us to select 46 sources published in 2005-2022. This review discusses new concepts about the stages of the course of compensated and decompensated LC, which differ in the severity of portal hypertension, the number and type of decompensation events, and patient survival. The clinical and prognostic value of acute LC decompensation, which manifests as recent ascites, bleeding, hepatic encephalopathy, bacterial infection, and requires hospitalization of the patient, was considered. The trajectories of the further development of acute decompensation, which are represented by stable or unstable decompensated LC, pre-ACLF, and ACLF, were discussed. Current European diagnostic criteria for ACLF, severity criteria for ACLF, and tools for predicting patient survival were reviewed. The latest data on the pathophysiological role of portal hypertension, systemic inflammation, metabolic disorders, and immunopathological cell damage in the development of organ failure in ACLF was given. The existing therapeutic measures and promising methods of treatment of patients with acute LC decompensation and ACLF were considered.