Gastroenterology · 2 h ago
Global liver-society consensus proposes harmonised ACLF definition
Five international liver societies developed a consensus framework for defining and diagnosing acute-on-chronic liver failure (ACLF), using literature review and a Delphi process. The recommendations include diagnostic thresholds for liver failure and distinguish patients with and without prior decompensation; the framework also aims to standardise research and trial endpoints.
- Five liver societies developed consensus statements using a Delphi process.
- Liver failure threshold: INR ≥1.5 and bilirubin ≥5 mg/dL.
- ACLF diagnosis should include advanced chronic liver disease, at least F3 fibrosis.
- Further research is needed to compare outcomes by decompensation history.
Acute-on-chronic liver failure (ACLF) is a life-threatening syndrome in people with chronic liver disease, but differing regional definitions have complicated diagnosis, comparisons between studies and international trials. Representatives of five liver societies—EASL, AASLD, APASL, ALEH and SOLDA—developed consensus statements through working groups, evidence review and Delphi rounds. Statements required more than 70% agreement; 12 revised statements underwent a second round. The endpoint statements were also discussed with US FDA representatives.
The consensus recommends that ACLF diagnosis include advanced chronic liver disease (at least F3 fibrosis) and identifies liver failure as the requisite core condition, defined as an INR of at least 1.5 and bilirubin of at least 5 mg/dL. It distinguishes type A ACLF, in patients without prior decompensation, from type B in those with previously decompensated cirrhosis. In type A, new ascites and/or hepatic encephalopathy may be present at presentation or develop within two to four weeks.
The authors say harmonisation could improve patient stratification, cross-study comparability and phase II/III trial design. This is a consensus framework, not a treatment trial; the supplied text notes that further research is needed to compare outcomes by prior or current decompensation. The full set of recommendations is not included in the source text provided.
In practice
For clinicians assessing patients with chronic liver disease, the consensus proposes that ACLF diagnosis require advanced chronic liver disease (at least F3 fibrosis) and liver failure, defined as INR ≥1.5 and bilirubin ≥5 mg/dL. It also separates patients with prior decompensation from those without, for whom new ascites and/or hepatic encephalopathy may develop within two to four weeks. These are consensus recommendations intended to harmonise practice and research; the supplied text does not provide the complete diagnostic and management framework, and further outcome comparisons are needed.
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Hepatology: Acute-on-chronic liver failure: A global multisociety consensus on definitions ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.