Fig. 2

Schematic diagram showing a paradigm for ACLF management. In the chronic liver disease stage, standardization of management protocols for the treatment of precipitating events is needed to close the “switch” of acute deterioration. Once patients develop to the acutely decompensated stage, different populations could be diagnosed using different criteria depending on the phenotype specificity of ACLF. Non-ACLF patients should be predicted the risk of progression to ACLF to prevent the onset of ACLF with intense intervention, while ACLF patients should be assessed for different prognostic stratifications by scores. Patients with ACLF who can derive a high survival benefit from LT by evaluation should be prioritized for liver transplantation, making efficient use of the limited donor organs and reducing the risk of futile transplantation. ACLF, acute-on-chronic liver failure; ALD, alcohol-related liver disease; HBV, hepatitis B virus; CLIF-C ACLFs, chronic liver failure consortium ACLF score; COSSH, Chinese Group on the Study of Severe Hepatitis B; COSSH- ACLF IIs, COSSH- ACLF II score; COSSH-onset-ACLFs, COSSH-onset-ACLF score; G-CSF, granulocyte colony-stimulating; SDC, stable decompensated cirrhosis; UDC, unstable decompensated cirrhosis