Acute-on-chronic liver failure (ACLF) has been defined differently by European, Asian-Pacific and North American groups, which has made trials hard to compare and left clinicians using different thresholds for the same patient. A global multisociety harmonisation initiative, published in Hepatology, sets out a single framework for definition, diagnosis and grading.
It builds on the existing regional definitions and covers patient stratification, assessment of organ dysfunction and failure, critical care management, transplantation, and standard end points for future phase 2 and 3 trials.
For clinicians in India, where APASL criteria have been widely used and ACLF often follows alcohol, hepatitis B flares or hepatitis E, a common definition should make international evidence easier to apply. Check the full consensus for the specific organ-failure criteria before changing local protocols.
- Expect future trials and guidance on ACLF to use one shared definition
- Review the consensus criteria against your unit's current ACLF definition
- Grade organ failures systematically in decompensated cirrhosis to identify ACLF early
- Discuss transplant candidacy early in patients meeting ACLF criteria
Why it matters
Patients labelled ACLF in one country and not in another made trial results hard to transfer.
Don't overread it
This is a consensus on definitions, not new evidence on treatment.
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