Table 1 Definition, incidence, mortality and prognostic clinical features cutoff for mortality increase in the different types of liver injury

ALF

Hepatic Encephalopathy

Coagulopathy: INR > 1.5

Absence of previous liver injury

Duration < 26 weeks

According to the interval from jaundice to HE appearance:

Bernuau:

Fulminant: < 2 weeks

Subfulminant: 2–12 weeks

O´Grady:

Hyperacute: < 1 week

Acute: 1–4 weeks

Subacute: 5–12 weeks

Japanese consensus

(if HE < II: without hepatic coma;

If HE ≥ grade II: with hepatic coma):

Fulminant: 0–8 weeks

 Acute: 0–10 days

 Subacute: 11–56 days

LOHF: > 56 days

 < 1%

Up to 50%

Grade of HE

Acute/hyperacute versus subacute/LOHF

Extrahepatic organ failure

AKI

Age

 < 10 or > 40 years

Lactate

 ≥ 4 mmol/l

Bilirubin (non-paracetamol)

 > 17 mg/dl

Arterial ammonia

 > 100 µmol/l

ACLF

EASL:

Acute deterioration:

Usually related to a precipitating event

 From extrahepatic origin or

 Secondary to superimposed liver injury

Preexisting liver disease:

 Chronic liver disease

High 90-day mortality due to multisystem organ failure

According to the presence of extrahepatic failure:

ACLF 1:

 Single kidney failure, or

 Single liver/coagulation/circulatory/respiratory failure and

  SCr: 1.5–1.9 mg/dl or

  Mild-to-moderate HE, or

  Single cerebral failure and SCr 1.5 mg/dl

ACLF 2:

 2 organ failures

ACLF 3:

  ≥ 3 organ failures

1–5%

(24–40% of patients with cirrhosis admitted to hospital)

28-day: 34%

 ACLF 1: 22%

 ACLF 2: 32%

 ACLF 3: 77%

90-day: 51%

 ACLF 1: 41%

 ACLF 2: 52%

 ACLF 3: 79%

Bilirubin

6–12 mg/dl

HE

Grade I-II

INR

2.0–2.5

MAP

 < 70 mmHg

Creatinine

2.0 mg/dl in single kidney failure, or

1.5–1.9 mg/dl in single non-kidney organ failure

Age

WBC count

Infection [6]

Number of organ failures

 ≥ 2

Respiratory function

PaO₂/FiO₂: 200–300, or

SpO₂/FiO₂: 214–357

NACSELD:

Cirrhosis and two extrahepatic organ failures

Organ failures are defined as

(1) Shock

(2) Grade III/IV hepatic encephalopathy (HE)

(3) Need for dialysis

(4) Mechanical ventilation

N.a

N.a

According to the number of organ failure and infection

1 OF: 10%/20%

2 OF: 16%/38%

3 OF: 35%/58%

 ≥ 4 OF: 0%/76%

Number of organ failure

 ≥ 2

APASL:

Acute hepatic insult:

 Jaundice: bilirubin ≥ 5 mg/dL

 Coagulopathy: INR ≥ 1.5 or PT activity < 40%

 Complicated within 4 weeks by

  Ascites and/or

  HE

Preexisting liver failure:

 Diagnosed or undiagnosed

 Chronic liver disease/cirrhosis

High 28-day mortality

Organ failure other than liver is not part of the definition

According to AARC Score [47], which defines the grade of liver failure:

Grade I (mild): 5–7

Grade II (severe): 8–10

Grade III (very severe): 11–15

1–5%

(24–40% of patients with cirrhosis admitted to hospital)

28-day: 33–44%

 Grade I: 12.7%

 Grade II: 44.5%

 Grade III: 85.9%

90 day: 47–53%

HE

Grade III-IV

Infection

INR

1.8–2.5

Lactate

1.5–2.5 mmol/l

Creatinine

1.1–1.5 mg/dl or AKIN Stage 1

Age

WBC count

Obesity

“Golden window”

Sepsis, MOF

Secondary Acquired Liver Injury

Cholestasis:

Altered bile excretion, synthesis or secretion

Bilirubin > 2 mg/dl (no consensus exist)

According to the mechanism:

Extrahepatic

Intrahepatic

11–36%

27–48%

Bilirubin

Bile acids

Concomitant syndromes

 > 2 mg/dl

 ≥ 5.2 µmol/l increase

Sepsis

Hypoxic Liver Injury:

Respiratory, cardiogenic or circulatory shock

Elevation of transaminases > 20-fold from the reference value

Absence of underlying liver injury

According to precipitating event:

Sepsis

Cardiogenic shock

Parenteral nutrition

10%

40–60%

SOFA score:

INR

Peak arterial ammonia

ICG-PDR

Concomitant syndromes

 ≥ 11

 > 2

 > 75 µmol/l

 < 9%/min

Sepsis