Acute-On-Chronic Liver Failure

Sudden liver failure in the presence of underlying compensated chronic LIVER DISEASE (e.g., LIVER CIRRHOSIS; HEPATITIS; and liver injury and failure) due to a precipitating acute hepatic insult.

Also Known As:

Acute On Chronic Liver Failure; Acute On Chronic Liver Failure (ACLF); Acute-On-Chronic Liver Failures; Acute-On-Chronic Liver Failures (ACLF); Failure, Acute-On-Chronic Liver; Failure, Acute-On-Chronic Liver (ACLF); Failures, Acute-On-Chronic Liver; Failures, Acute-On-Chronic Liver (ACLF); Liver Failure, Acute On Chronic; Liver Failure, Acute-On-Chronic (ACLF); Liver Failures, Acute-On-Chronic; Liver Failures, Acute-On-Chronic (ACLF); Acute-On-Chronic Liver Failure (ACLF); Liver Failure, Acute-On-Chronic

Networked: 1062 relevant articles (74 outcomes, 138 trials/studies)

Relationship Network

Disease Context: Research Results

Digestive System Diseases: 1042
- Liver Diseases: 41660
  - Hepatic Insufficiency: 1058
    - Liver Failure: 8775
      - Acute Liver Failure: 7208
        Acute-On-Chronic Liver Failure: 1062

Related Diseases

1.	Hepatitis B
2.	Acute Liver Failure (Fulminant Hepatic Failure)
3.	Fibrosis (Cirrhosis)
4.	Acute Kidney Injury (Acute Renal Failure)
5.	End Stage Liver Disease

Experts

1.	Jalan, Rajiv: 39 articles (11/2022 - 10/2002)
2.	Trebicka, Jonel: 28 articles (05/2022 - 10/2017)
3.	Arroyo, Vicente: 22 articles (01/2022 - 02/2007)
4.	Sundaram, Vinay: 18 articles (03/2022 - 01/2019)
5.	Sarin, Shiv Kumar: 17 articles (11/2021 - 03/2011)
6.	Maiwall, Rakhi: 16 articles (12/2021 - 09/2014)
7.	Chen, Yu: 15 articles (06/2022 - 10/2007)
8.	Karvellas, Constantine J: 15 articles (03/2022 - 11/2012)
9.	Zhang, Jing: 13 articles (08/2022 - 10/2007)
10.	Duan, Zhongping: 13 articles (06/2022 - 01/2014)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Acute-On-Chronic Liver Failure:

1.	Granulocyte Colony-Stimulating Factor (G-CSF)IBA 12/01/2021 - "Based on positive results from small single center studies, granulocyte-colony stimulating factor (G-CSF) is being widely used for the treatment of patients with acute-on-chronic liver failure (ACLF). " 12/01/2021 - "NCT02669680 LAY SUMMARY: Granulocyte-colony stimulating factor was considered as a novel treatment for acute-on-chronic liver failure (ACLF). " 10/16/2023 - "Efficacy of Granulocyte Colony-Stimulating Factor in Acute on Chronic Liver Failure: A Systematic Review and Survival Meta-Analysis." 01/01/2023 - "The safety and efficacy of granulocyte-colony stimulating factor (G-CSF) for the treatment of acute-on-chronic liver failure (ACLF) remain controversial. " 11/01/2021 - "The safety and efficacy of granulocyte colony-stimulating factor (G-CSF) for the treatment of acute-on-chronic liver failure (ACLF) remain uncertain. "
2.	AlbuminsIBA 01/01/2007 - "In particular, many investigations have examined the therapeutic mechanisms and efficacy of artificial albumin dialysis based systems in acute on chronic liver failure, the results of which have been conflicting. " 01/01/2023 - "The purpose of this study was to investigate the predictive value of the prothrombin time-international normalized ratio to albumin ratio (PTAR) for mortality in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). " 03/01/2013 - "Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure: the RELIEF trial." 09/01/2004 - "Pathophysiological effects of albumin dialysis in acute-on-chronic liver failure: a randomized controlled study." 01/01/2023 - "Predictive Value of the Prothrombin Time-International Normalized Ratio to Albumin Ratio in the Prognosis of Patients with Hepatitis B Virus-Related Acute-on-Chronic Liver Failure."
3.	entecavir FDA Link 01/01/2020 - "The study is aimed at comparing the incidence of acute kidney injury (AKI) between TDF and entecavir (ETV) treatment in hepatitis B virus- (HBV-) related acute on chronic liver failure (ACLF). " 05/01/2016 - "Various studies showed that entecavir (ETV) failed to improve the short-term survival in chronic hepatitis B (CHB) patients with severe acute exacerbation (SAE) and hepatic de-compensation or acute-on-chronic liver failure (ACLF). " 12/01/2016 - "Umbilical Cord-Derived Mesenchymal Stem Cell Transplantation in Hepatitis B Virus Related Acute-on-Chronic Liver Failure Treated with Plasma Exchange and Entecavir: a 24-Month Prospective Study." 06/01/2013 - "Entecavir improves the outcome of acute-on-chronic liver failure due to the acute exacerbation of chronic hepatitis B." 10/01/2012 - "Entecavir treatment prevents disease progression in hepatitis B virus-related acute-on-chronic liver failure: establishment of a novel logistical regression model."
4.	TerlipressinIBA 01/01/2023 - "Non-response to terlipressin can predict 90-day mortality in acute-on-chronic-liver failure. " 01/01/2023 - "Editorial: terlipressin in patients with acute-on-chronic liver failure grade 3-too late?" 01/01/2019 - "Acute-on-chronic liver failure grade independently predicts response to terlipressin treatment. " 04/01/2021 - "Terlipressin modulates PV flow but effects on HA, TLBF, and sepsis/acute-on-chronic liver failure (ACLF)-induced haemodynamic changes are poorly characterised. " 12/01/2020 - "Terlipressin is an effective drug for HRS reversal in patients with liver cirrhosis and acute-on-chronic liver failure. "
5.	Lamivudine (Epivir)FDA Link 04/01/2016 - "The aim of this study was to reveal the association between serum M65 levels and outcomes of hepatitis B virus-related acute-on-chronic liver failure, and to further clarify clinical significance of M65 in lamivudine treatment. " 04/01/2016 - "Ninety-six patients with hepatitis B virus-related acute-on-chronic liver failure were recruited between January 2011 and December 2013, and 52 of them received lamivudine treatment. " 11/01/2014 - "Prediction of prognosis to lamivudine in patients with spontaneous reactivation of hepatitis B virus-related acute-on-chronic liver failure: using virologic response at week 4." 06/01/2012 - "[Efficacy of lamivudine on acute-on-chronic liver failure in patients with chronic hepatitis B]." 01/01/2017 - "Lamivudine improves short-term outcome in hepatitis B virus-related acute-on-chronic liver failure patients with a high model for end-stage liver disease score."
6.	Norepinephrine (Noradrenaline)FDA LinkGeneric 12/01/2018 - "Noradrenaline for Hepatorenal Syndrome in Patients With Acute on Chronic Liver Failure: Hope Remains!" 01/01/2020 - "Terlipressin Is Superior to Noradrenaline in the Management of Acute Kidney Injury in Acute on Chronic Liver Failure." 12/01/2018 - "Letter To Editor: Terlipressin is Superior to Noradrenaline in the Management of Acute Kidney Injury in Acute On Chronic Liver Failure." 01/01/2019 - "Is Terlipressin Superior to Noradrenaline in the Treatment of Acute Kidney Injury in Acute-on-Chronic Liver Failure?" 01/01/2021 - "Recent randomized controlled trials have established (a) the efficacy of (long-term) albumin in the prevention of complications of ascites (including HRS-AKI), (b) the benefits of transjugular intrahepatic portosystemic shunt placement in patients with recurrent ascites, and (c) the superiority of terlipressin over noradrenaline for the treatment of HRS-AKI in the context of acute-on-chronic liver failure. "
7.	HMGB1 Protein (HMG1)IBA 07/01/2013 - "In this study, specific monoclonal anti-HMGB1 antibody was administered to rats with acute on chronic liver failure (ACLF) in order to evaluate the therapeutic efficacy of HMGB1 blockade. " 01/01/2022 - "Jieduan-Niwan Formula Ameliorates Oxidative Stress and Apoptosis in Acute-on-Chronic Liver Failure by Suppressing HMGB1/TLR-4/NF-κB Signaling Pathway: A Study In Vivo and In Vitro." 01/01/2022 - "Determination of HMGB1 in hepatitis B virus-related acute-on-chronic liver failure patients with acute kidney injury: Early prediction and prognostic implications." 06/01/2017 - "The aim of this study was to evaluate the correlation of High-mobility group box 1 (HMGB1) expression in the serum with chronic hepatitis B (CHB) related liver fibrosis, severe hepatitis B and acute-on-chronic liver failure (ACLF). " 07/01/2017 - "Areas covered: In this review, we focus on the relationship between causes of acute liver failure, such as viral infection, drug-induced liver injury, ischemia/reperfusion injury, and acute-on-chronic liver failure, and the role of HMGB1. "
8.	Anti-Bacterial Agents (Antibiotics)IBA 11/01/2018 - "This study aims to determine the safety and efficacy of antibiotics within acute-on-chronic liver failure. " 09/12/2023 - "In acute-on-chronic liver failure (ACLF), adequate antibiotic dosing is challenging due to changes of drug distribution and elimination. " 01/01/2023 - "The detected viral signature had clinical correlates, including clinical efficacy of empirical antibiotic treatment, progression to acute-on-chronic liver failure and short-term mortality. " 01/01/2023 - "A NHV signature was identified in individuals with AD, and CMV was the most frequent NHV, which correlated with the clinical effect of empirical antibiotic treatment, progression to acute-on-chronic liver failure, and 90-day mortality. " 03/31/2021 - "The role of prophylactic antibiotics in hepatitis B virus-related acute-on-chronic liver failure patients at risk of bacterial infection: a retrospective study."
9.	Tenofovir (Viread)FDA Link 01/01/2020 - "The Risk of Acute Kidney Injury in Hepatitis B Virus-Related Acute on Chronic Liver Failure with Tenofovir Treatment." 03/01/2011 - "Tenofovir improves the outcome in patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure." 07/01/2021 - "The aim of the study was to compare the safety and efficacy of tenofovir versus entecavir for treatment of naive acute on chronic liver failure (ACLF) due to hepatitis B virus (HBV) (ACLF-B). " 07/01/2021 - "Comparative role of tenofovir versus entecavir for treating patients with hepatitis B virus-related acute on chronic liver failure." 06/01/2021 - "Observational study on the response of tenofovir monotherapy versus tenofovir plus telbivudine dual therapy in patients with hepatitis B virus related acute on chronic liver failure."
10.	Methylprednisolone FDA LinkGeneric 10/01/2014 - "The aim of this study was to establish a new model of acute-on-chronic liver failure in rats and to investigate the protective effects of methylprednisolone on this model. " 12/08/2020 - "The efficacy and safety of methylprednisolone in hepatitis B virus-related acute-on-chronic liver failure: a prospective multi-center clinical trial." 10/01/2014 - "This model could be useful for further research into acute-on-chronic liver failure and methylprednisolone may be a potential therapeutic agent for this disease." 10/01/2014 - "The liver protective effect of methylprednisolone on a new experimental acute-on-chronic liver failure model in rats." 09/01/2012 - "Improved survival ratios correlate with myeloid dendritic cell restoration in acute-on-chronic liver failure patients receiving methylprednisolone therapy."

Therapies and Procedures

1.	Therapeutics 12/01/2004 - "However, in a well known but not very well defined entity of acute on chronic liver failure (AOCLF) the ECAD technique has been shown to improve survival compared to a similar randomized control group receiving standard supportive therapy. " 01/01/2022 - "Objectives: To assess the efficacy of LiangXue JieDu (LXJD) therapy in combination with Western medicine (WM) for acute-on-chronic liver failure (ACLF). " 11/25/2023 - "This study investigated the phenotypic heterogeneity of immunocytes in patients with HBV-related acute-on-chronic liver failure (HBV-ACLF) before and after ALSS therapy. " 08/01/2021 - "A phase II study of human allogeneic liver-derived progenitor cell therapy for acute-on-chronic liver failure and acute decompensation." 02/17/2023 - "Potential therapies for acute-on-chronic liver failure."
2.	Liver Transplantation 01/01/2022 - "There is growing evidence that liver transplantation (LT) is the most effective treatment for acute-on-chronic liver failure grade-3 (ACLF-3). " 12/01/2021 - "Uncertainties exist surrounding the timing of liver transplantation (LT) among patients with acute-on-chronic liver failure grade 3 (ACLF-3), regarding whether to accept a marginal quality donor organ to allow for earlier LT or wait for either an optimal organ offer or improvement in the number of organ failures, in order to increase post-LT survival. " 02/01/2022 - "Improved Survival With Higher-risk Donor Grafts in Liver Transplant With Acute-on-chronic Liver Failure." 01/01/2022 - "Liver transplantation (LT) is the only effective treatment for acute-on-chronic liver failure (ACLF), but it is limited by organ availability. " 01/01/2022 - "Liver Transplantation as a Cornerstone Treatment for Acute-On-Chronic Liver Failure."
3.	Plasma Exchange 08/28/2023 - "To investigate the safety and efficacy of double plasma molecular adsorption system (DPMAS) with sequential low-dose plasma exchange (LPE) in treating early hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). " 01/01/2022 - "Efficacy of sequential double plasma molecular adsorb system (DPMAS) and plasma exchange (PE) on patients with acute on chronic liver failure (ACLF) has been rarely reported. " 12/01/2022 - "Plasma exchange for patients with acute or acute on chronic liver failure; meta-analysis of randomized controlled trials." 01/01/2022 - "This study aims to investigate the clinical efficacy of plasma exchange in treating acute-on-chronic liver failure (ACLF) through meta-analysis. " 08/28/2023 - "Double Plasma Molecular Adsorption System with Sequential Low-dose Plasma Exchange in Patients with Hepatitis B Virus-related Acute-on-chronic Liver Failure: A Prospective Study."
4.	Artificial Liver (Bioartificial Liver) 04/28/2023 - "Nonbiological artificial liver (NBAL) is frequently used as a first-line treatment for hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). " 01/01/2023 - "To evaluate the short-term and long-term survival efficacy of an artificial liver support system (ALSS) in patients with acute-on-chronic liver failure (ACLF). " 08/01/2019 - "The artificial liver support system (ALSS) is used frequently as a first-line treatment for hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). " 11/25/2023 - "Characteristics of circulating immune cells in HBV-related acute-on-chronic liver failure following artificial liver treatment." 10/24/2023 - "Evaluating the Effect of Artificial Liver Support on Acute-on-Chronic Liver Failure Using the Quantitative Difference Algorithm: Retrospective Study."
5.	Transplantation 01/01/2022 - "Immunosuppression in patients with grade 3 acute-on-chronic liver failure at transplantation: A practice analysis study." 06/01/2021 - "This study aims to validate Japanese diagnostic criteria for acute-on-chronic liver failure (ACLF) and confirm the feasibility of performing transplantation. " 11/17/2023 - "[Transplantation for acute-on-chronic liver failure]." 10/06/2023 - "Old age, acute on chronic liver failure, re-transplantation, preoperative intensive care unit stay and red blood cell (RBC) transfusion during the operation were risk factors for graft failure (p = .046, .005, .032, .015 and .001, respectively). " 12/28/2022 - "Current and future perspectives on acute-on-chronic liver failure: Challenges of transplantation, machine perfusion, and beyond."