{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:19:56Z","timestamp":1777450796950,"version":"3.51.4"},"reference-count":68,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2018,9,22]],"date-time":"2018-09-22T00:00:00Z","timestamp":1537574400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,9,22]],"date-time":"2018-09-22T00:00:00Z","timestamp":1537574400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:p>Acute on chronic liver failure (ACLF) is the culmination of chronic liver disease and extrahepatic organ failures, which is associated with a high short\u2010term mortality and immense health care expenditure. There are varying definitions for organ failures and ACLF in Europe, North America, and Asia. These differing definitions need to be reconciled to enhance progress in the field. The pathogenesis of ACLF is multifactorial and related to interactions between the immunoinflammatory system, microbiota, and the various precipitating factors. Individual organ failures related to the kidney, brain, lungs, and circulation have cumulative adverse effects on mortality and are often complicated or precipitated by infections. Strategies to prevent and rapidly treat these organ failures are paramount in improving survival. With the aging population and paucity of organs for liver transplant, the prognosis of ACLF patients is poor, highlighting the need for novel therapeutic strategies. The role of liver transplant in ACLF is evolving and needs further investigation across large consortia. A role for early palliative care and management of frailty as approaches to alleviate disease burden and improve patient\u2010reported outcomes is being increasingly recognized.<\/jats:p>\n          <jats:p>\n                           <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>: ACLF is a clinically relevant syndrome that is epidemic worldwide and requires a dedicated multinational approach focused on prognostication and management; investigations are underway worldwide to prepare ACLF for prime time. (H<jats:sc>epatology<\/jats:sc> 2018; 00:000\u2010000)<\/jats:p>","DOI":"10.1002\/hep.30056","type":"journal-article","created":{"date-parts":[[2018,4,24]],"date-time":"2018-04-24T19:24:49Z","timestamp":1524597889000},"page":"1621-1632","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":94,"title":["Acute\u2010on\u2010Chronic Liver Failure: Getting Ready for Prime Time?"],"prefix":"10.1097","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4928-3681","authenticated-orcid":false,"given":"Jasmohan S.","family":"Bajaj","sequence":"first","affiliation":[{"name":"Virginia Commonwealth University and McGuire VA Medical Center,Richmond,VA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Moreau","sequence":"additional","affiliation":[{"name":"INSERM, Universit\u00e9 Paris Diderot\u2010Paris 7, Centre de Recherche sur l'Inflammation, Paris, France; D\u00e9partement Hospitalo\u2010Universitaire UNITY, Service d'H\u00e9patologie,H\u00f4pital Beaujon, Assistance Publique\u2010H\u00f4pitaux de Paris,Clichy,France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick S","family":"Kamath","sequence":"additional","affiliation":[{"name":"Mayo Clinic,Rochester,MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugo E.","family":"Vargas","sequence":"additional","affiliation":[{"name":"Mayo Clinic,Scottsdale,AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicente","family":"Arroyo","sequence":"additional","affiliation":[{"name":"EF\u2010CLIF Foundation,Barcelona,Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4898-7778","authenticated-orcid":false,"given":"K. Rajender","family":"Reddy","sequence":"additional","affiliation":[{"name":"University of Pennsylvania,Philadelphia,PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gyongyi","family":"Szabo","sequence":"additional","affiliation":[{"name":"University of Massachusetts,Worcester,MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Puneeta","family":"Tandon","sequence":"additional","affiliation":[{"name":"University of Alberta,Edmonton,AB,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jody","family":"Olson","sequence":"additional","affiliation":[{"name":"University of Kansas,Kansas City,KS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1555-1089","authenticated-orcid":false,"given":"Constantine","family":"Karvellas","sequence":"additional","affiliation":[{"name":"University of Alberta,Edmonton,AB,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thierry","family":"Gustot","sequence":"additional","affiliation":[{"name":"Erasme University,Brussels,Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer C.","family":"Lai","sequence":"additional","affiliation":[{"name":"University of California,San Francisco,CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florence","family":"Wong","sequence":"additional","affiliation":[{"name":"University of Toronto,Toronto,ON,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2018,9,22]]},"reference":[{"key":"hep30056-bib-0001-20241017","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1007\/s11894-012-0308-y","article-title":"Natural history of cirrhosis","volume":"15","year":"2013","journal-title":"Curr Gastroenterol 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