Table 1 Definitions, diagnostic criteria and stratification of ACLF proposed by each of the four major international scientific consortia

Study type

Multicentre, prospective, observational study

Multicentre, prospective, observational study

Expert consensus report

Multicentre, prospective, observational study

Main aetiology

Alcohol, HCV

HBV

HBV

Alcohol

Precipitating events

Intrahepatic (alcoholic hepatitis), extrahepatic (infection, variceal haemorrhage), or both

Intrahepatic (HBV reactivation), extrahepatic (bacterial infection) or both

Intrahepatic

Intrahepatic, extrahepatic or both

Population

Compensated and decompensated cirrhosis

HBV-related chronic liver disease

Chronic liver disease

Compensated cirrhosis

Compensated and decompensated cirrhosis

Criteria of Organ failure

Liver: total bilirubin ≥ 12 mg/dL;

Kidney: creatinine ≥ 2 mg/dL or use of RRT;

Coagulation: INR ≥ 2.5;

Brain: West Haven grade 3–4 HE or use of mechanical ventilation due to HE;

Circulation: Use of vasopressors;

Respiration: PaO2/FiO2 ≤ 200 or SpO2/FiO2 ≤ 214,

or use of mechanical ventilation not due to HE

Liver: Total bilirubin ≥ 12 mg/dL;

Kidney: Creatinine ≥ 2 mg/dL or use of RRT;

Coagulation: INR ≥ 2.5;

Brain: West Haven grade 3–4 HE or use of mechanical ventilation due to HE;

Circulation: Use of vasopressors;

Respiration: PaO2/FiO2 ≤ 200 or SpO2/FiO2 ≤ 214,

or use of mechanical ventilation not due to HE

Liver: Total bilirubin ≥ 5 mg/dL;

Brain: clinical HE

Kidney: Use of dialysis or other form of RRT;

Brain: HE Grade 3–4 in West Haven classification;

Circulation: MAP < 60 mmHg or reduction of 40 mmHg in

SBP from baseline, in spite of fluid resuscitation and adequate cardiac output;

Respiration: Use of mechanical ventilation

Criteria for the presence of ACLF and ACLF stratification

ACLF is divided into 3 grades of increasing severity

Grade 1 includes 3 subgroups:

(1) single kidney failure; (2) single liver, coagulation, circulatory or respiratory failure with either kidney dysfunction, brain dysfunction, or both;

(3) single brain failure and kidney dysfunction;

Grade 2: 2 organ failures;

Grade 3: 3 or more organ failures

ACLF is divided into 3 grades of increasing severity

Grade 1 includes 4 subgroups:

(1) single kidney failure; (2) single liver failure and either INR ≥ 1.5, kidney dysfunction, brain dysfunction, or any combination of these alterations;

(3) single coagulation, circulatory or respiratory failure with either kidney dysfunction, brain dysfunction, or both;

(4) brain failure alone plus kidney dysfunction;

Grade 2: 2 organ failures;

Grade 3: 3 or more organ failures

Acute hepatic insult manifesting as jaundice (total bilirubin levels of 5 mg/dl or more) and coagulopathy (INR ≥ 1.5, or prothrombin activity < 40%) complicated within 4 weeks by clinical ascites, HE, or both

The severity of ACLF is assessed using the AARC score

Grade 1: 5–7 scores,

Grade 2: 8–10 scores,

Grade 3: 11–15 scores

Patients are stratified according to the number of organ failures 2, 3, or all 4 organ failures

Prevalence of ACLF grade

Grade 1: 49%

Grade 2: 35%

Grade 3: 16%

Grade 1: 61%

Grade 2: 33%

Grade 3: 6%

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2 Organ failures: 43%

3 Organ failures: 41%

4 Organ failures: 16%

Main organ failures

Kidney, Liver

Liver, Coagulation

Liver, Coagulation

Brain

Short-term mortality rate of ACLF

By 28 days:

Grade 1: 22%

Grade 2: 32%

Grade 3: 77%

By 28 days:

Grade 1: 23%

Grade 2: 61%

Grade 3: 93%

By 28 days:

Grade 1: 13%

Grade 2: 45%

Grade 3: 86%

By 30 days:

2 Organ failures: 49%

3 Organ failures: 64%

4 Organ failures: 77%