{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T21:29:40Z","timestamp":1780694980790,"version":"3.54.1"},"reference-count":49,"publisher":"Elsevier BV","issue":"3","license":[{"start":{"date-parts":[[2016,9,1]],"date-time":"2016-09-01T00:00:00Z","timestamp":1472688000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2016,9,1]],"date-time":"2016-09-01T00:00:00Z","timestamp":1472688000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jcehepatology.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical and Experimental Hepatology"],"published-print":{"date-parts":[[2016,9]]},"DOI":"10.1016\/j.jceh.2016.08.011","type":"journal-article","created":{"date-parts":[[2016,9,9]],"date-time":"2016-09-09T13:29:52Z","timestamp":1473427792000},"page":"233-240","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":17,"title":["Acute on Chronic Liver Failure\u2014What is in a \u2018Definition\u2019?"],"prefix":"10.1016","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7105-1540","authenticated-orcid":false,"given":"Anil C.","family":"Anand","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radha K.","family":"Dhiman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jceh.2016.08.011_bib0250","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/0140-6736(93)91818-7","article-title":"Acute liver failure: redefining the syndromes","volume":"342","author":"O\u2019Grady","year":"1993","journal-title":"Lancet"},{"key":"10.1016\/j.jceh.2016.08.011_bib0255","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1055\/s-2008-1040593","article-title":"Fulminant and subfulminant liver failure: definitions and causes","volume":"6","author":"Bernuau","year":"1986","journal-title":"Semin Liver Dis"},{"key":"10.1016\/j.jceh.2016.08.011_bib0260","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1002\/hep.1840060222","article-title":"Late onset hepatic failure: clinical, serological and histological features","volume":"6","author":"Gimson","year":"1986","journal-title":"Hepatology"},{"key":"10.1016\/j.jceh.2016.08.011_bib0265","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1002\/hep.22177","article-title":"Acute liver failure: summary of a workshop","volume":"47","author":"Lee","year":"2008","journal-title":"Hepatology"},{"issue":"3","key":"10.1016\/j.jceh.2016.08.011_bib0270","first-page":"124","article-title":"Subacute hepatic failure","volume":"1","author":"Tandon","year":"1988","journal-title":"Nat Med J India"},{"issue":"March (3)","key":"10.1016\/j.jceh.2016.08.011_bib0275","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1038\/nrgastro.2015.219","article-title":"Acute-on-chronic liver failure: terminology, mechanisms and management","volume":"13","author":"Sarin","year":"2016","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"10.1016\/j.jceh.2016.08.011_bib0280","first-page":"217","article-title":"Acute-on-chronic liver failure","author":"Ohnishi","year":"1995","journal-title":"Ryoikibetsu Shokogun Shirizu"},{"key":"10.1016\/j.jceh.2016.08.011_bib0285","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1007\/s005350200099","article-title":"Decreasing serum alpha-fetoprotein levels in predicting poor prognosis of acute hepatic failure in patients with chronic hepatitis B","volume":"37","author":"Yang","year":"2002","journal-title":"J Gastroenterol"},{"key":"10.1016\/j.jceh.2016.08.011_bib0290","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1159\/000047017","article-title":"Acute on chronic liver failure: pathophysiological basis of therapeutic options","volume":"20","author":"Jalan","year":"2002","journal-title":"Blood Purif"},{"issue":"9","key":"10.1016\/j.jceh.2016.08.011_bib0295","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1002\/lt.20236","article-title":"Pathophysiological effects of albumin dialysis in acute on Chronic Liver Failure: a randomised controlled study","volume":"10","author":"Sen","year":"2004","journal-title":"Liver Transpl"},{"issue":"February (2)","key":"10.1016\/j.jceh.2016.08.011_bib0300","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.jhep.2004.10.019","article-title":"Patients with acute on chronic liver failure display \u201csepsis-like\u201d immune paralysis","volume":"42","author":"Wasmuth","year":"2005","journal-title":"J Hepatol"},{"key":"10.1016\/j.jceh.2016.08.011_bib0305","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1111\/j.1440-1746.2006.04510.x","article-title":"Prediction of the prognosis in patients with acute-on-chronic hepatitis using the MELD scoring system","volume":"21","author":"Yu","year":"2006","journal-title":"J Gastroenterol Hepatol"},{"key":"10.1016\/j.jceh.2016.08.011_bib0310","doi-asserted-by":"crossref","first-page":"R108","DOI":"10.1186\/cc4985","article-title":"Effect of the molecular adsorbent recirculating system and Prometheus devices on systemic haemodynamics and vasoactive agents in patients with acute-on-chronic alcoholic liver failure","volume":"10","author":"Laleman","year":"2006","journal-title":"Crit Care"},{"key":"10.1016\/j.jceh.2016.08.011_bib0315","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1016\/j.transproceed.2007.02.070","article-title":"Impact of pretransplant MELD score on post transplant outcome in orthotopic liver transplantation for patients with acute-on-chronic hepatitis B liver failure","volume":"39","author":"Wang","year":"2007","journal-title":"Transpl Proc"},{"key":"10.1016\/j.jceh.2016.08.011_bib0320","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s12072-008-9106-x","article-title":"Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL)","volume":"3","author":"Sarin","year":"2009","journal-title":"Hepatol Int"},{"key":"10.1016\/j.jceh.2016.08.011_bib0325","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1111\/j.1478-3231.2008.01887.x","article-title":"Clinical features and predictors of outcome in acute hepatitis A and hepatitis E virus hepatitis on cirrhosis","volume":"29","author":"Krishna","year":"2009","journal-title":"Liver Int"},{"key":"10.1016\/j.jceh.2016.08.011_bib0330","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/j.1365-2893.2008.01046.x","article-title":"Prediction of the prognosis of patients with acute-on-chronic hepatitis B liver failure using the model for end-stage liver disease scoring system and a novel logistic regression model","volume":"16","author":"Sun","year":"2009","journal-title":"J Viral Hepat"},{"key":"10.1016\/j.jceh.2016.08.011_bib0335","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.bbrc.2010.09.096","article-title":"Skewed ratios between CD3(+) T cells and monocytes are associated with poor prognosis in patients with HBV-related acute-on-chronic liver failure","volume":"402","author":"Shi","year":"2010","journal-title":"Biochem Biophys Res Commun"},{"key":"10.1016\/j.jceh.2016.08.011_bib0340","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1016\/j.transproceed.2010.03.095","article-title":"Predictive parameters after molecular absorbent recirculating system treatment integrated with model for end stage liver disease model in patients with acute-on-chronic liver failure","volume":"42","author":"Novelli","year":"2010","journal-title":"Transpl Proc"},{"key":"10.1016\/j.jceh.2016.08.011_bib0345","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1136\/gut.2009.189639","article-title":"Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study","volume":"59","author":"Katoonizadeh","year":"2010","journal-title":"Gut"},{"key":"10.1016\/j.jceh.2016.08.011_bib0350","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/CCM.0b013e3181b42a1c","article-title":"Bacteremia, acute physiology and chronic health evaluation II and modified end stage liver disease are independent predictors of mortality in critically ill non transplanted patients with acute on chronic liver failure","volume":"38","author":"Karvellas","year":"2010","journal-title":"Crit Care Med"},{"key":"10.1016\/j.jceh.2016.08.011_bib0355","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1089\/vim.2010.0135","article-title":"The ratio of Th-17 to Treg cells is associated with survival of patients with acute-on-chronic hepatitis B liver failure","volume":"24","author":"Zhai","year":"2011","journal-title":"Viral Immunol"},{"key":"10.1016\/j.jceh.2016.08.011_bib0360","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s00535-010-0315-4","article-title":"Association of hepatitis B virus mutations in basal core promoter and precore regions with severity of liver disease: an investigation of 793 Chinese patients with mild and severe chronic hepatitis B and acute-on-chronic liver failure","volume":"46","author":"Zhihui","year":"2011","journal-title":"J Gastroenterol"},{"key":"10.1016\/j.jceh.2016.08.011_bib0365","doi-asserted-by":"crossref","first-page":"3448","DOI":"10.3748\/wjg.v17.i29.3448","article-title":"Survival and prognostic factors in hepatitis B virus-related acute-on-chronic liver failure","volume":"17","author":"Huang","year":"2011","journal-title":"World J Gastroenterol"},{"key":"10.1016\/j.jceh.2016.08.011_bib0370","first-page":"165","article-title":"Acute-on-chronic liver failure: concept, natural history, and prognosis","volume":"17","author":"Olson","year":"2011","journal-title":"Curr Opin Crit Care"},{"key":"10.1016\/j.jceh.2016.08.011_bib0375","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1111\/j.1478-3231.2012.02790.x","article-title":"A systematic review on prognostic indicators of acute on chronic liver failure and their predictive value for mortality","volume":"33","author":"Wlodzimirow","year":"2013","journal-title":"Liver Int"},{"key":"10.1016\/j.jceh.2016.08.011_bib0380","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1053\/j.gastro.2013.02.042","article-title":"Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis","volume":"144","author":"Moreau","year":"2013","journal-title":"Gastroenterology"},{"key":"10.1016\/j.jceh.2016.08.011_bib0385","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1002\/hep.27077","article-title":"Survival in sepsis-related acute-on-chronic liver failure is defined by extrahepatic organ failures","volume":"60","author":"Bajaj","year":"2014","journal-title":"Hepatology"},{"issue":"1","key":"10.1016\/j.jceh.2016.08.011_bib0390","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1053\/j.gastro.2014.05.005","article-title":"Toward an improved definition of acute-on-chronic liver failure","volume":"147","author":"Rajiv","year":"2014","journal-title":"Gastroenterology"},{"key":"10.1016\/j.jceh.2016.08.011_bib0395","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1007\/s12072-014-9580-2","article-title":"Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014","volume":"8","author":"Sarin","year":"2014","journal-title":"Hepatol Int"},{"key":"10.1016\/j.jceh.2016.08.011_bib0400","article-title":"Acute on chronic liver failure in India: the INASL Consortium experience","volume":"March","author":"Shalimar","year":"2016","journal-title":"J Gastroenterol Hepatol"},{"key":"10.1016\/j.jceh.2016.08.011_bib0405","series-title":"Portal Hypertension VI. Proceedings of the Sixth Baveno Consensus Workshop: Stratifying Risk and Individualizing Care","first-page":"39","article-title":"Identifying compensated advanced chronic liver disease: when not to start screening for varices and clinically significant portal hypertension","author":"Augustin","year":"2016"},{"issue":"10","key":"10.1016\/j.jceh.2016.08.011_bib0410","doi-asserted-by":"crossref","first-page":"3188","DOI":"10.1007\/s10620-010-1377-0","article-title":"Non hepatic insults are common precipitants in patients with acute on chronic liver failure (ACLF)","volume":"55","author":"Duseja","year":"2010","journal-title":"Dig Dis Sci"},{"key":"10.1016\/j.jceh.2016.08.011_bib0415","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1111\/j.1478-3231.2008.01887.x","article-title":"Clinical features and predictors of outcome in acute hepatitis A and hepatitis E virus hepatitis on cirrhosis","volume":"29","author":"Radha Krishna","year":"2009","journal-title":"Liver Int"},{"key":"10.1016\/j.jceh.2016.08.011_bib0420","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1002\/hep.27849","article-title":"Clinical course of acute-on-chronic liver failure syndrome and effects on prognosis","volume":"62","author":"Gustot","year":"2015","journal-title":"Hepatology"},{"key":"10.1016\/j.jceh.2016.08.011_bib0425","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1136\/gutjnl-2011-301762","article-title":"Prospective derivation and validation of early dynamic model for predicting outcome in patients with acute liver failure","volume":"61","author":"Kumar","year":"2012","journal-title":"Gut"},{"key":"10.1016\/j.jceh.2016.08.011_bib0430","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1002\/lt.24139","article-title":"High risk of delisting or death in liver transplant candidates following infections: results from NACSELD","volume":"21","author":"Reddy","year":"2015","journal-title":"Liver Transpl"},{"key":"10.1016\/j.jceh.2016.08.011_bib0435","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1111\/jgh.12778","article-title":"Simple organ failure count versus CANONIC grading system for predicting mortality in acute-on-chronic liver failure","volume":"30","author":"Agrawal","year":"2015","journal-title":"J Gastroenterol Hepatol"},{"key":"10.1016\/j.jceh.2016.08.011_bib0440","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1111\/liv.12597","article-title":"Single-centre validation of the EASL-CLIF consortium definition of acute-on-chronic liver failure and CLIF-SOFA for prediction of mortality in cirrhosis","volume":"35","author":"Silva","year":"2015","journal-title":"Liver Int"},{"issue":"October (40)","key":"10.1016\/j.jceh.2016.08.011_bib0445","doi-asserted-by":"crossref","first-page":"14934","DOI":"10.3748\/wjg.v20.i40.14934","article-title":"Chronic Liver Failure-Sequential Organ Failure Assessment is better than the Asia-Pacific Association for the Study of Liver criteria for defining acute-on-chronic liver failure and predicting outcome","volume":"20","author":"Dhiman","year":"2014","journal-title":"World J Gastroenterol"},{"key":"10.1016\/j.jceh.2016.08.011_bib0450","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.dld.2011.08.029","article-title":"Clinical profile and predictors of mortality in patients of acute on chronic liver failure","volume":"44","author":"Garg","year":"2012","journal-title":"Dig Liver Dis"},{"issue":"October (4)","key":"10.1016\/j.jceh.2016.08.011_bib0455","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1053\/j.gastro.2010.06.019","article-title":"Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis","volume":"139","author":"Arvaniti","year":"2010","journal-title":"Gastroenterology"},{"issue":"May (5)","key":"10.1016\/j.jceh.2016.08.011_bib0460","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1038\/nm0509-496","article-title":"Tilting toward immunosuppression","volume":"15","author":"Hotchkiss","year":"2009","journal-title":"Nat Med"},{"issue":"1","key":"10.1016\/j.jceh.2016.08.011_bib0465","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/S0168-8278(14)60071-4","article-title":"Albumin infusion for bacterial infections other than spontaneous bacterial peritonitis in cirrhostic patients: a multicenter randomized controlled study (ALB-CIRINF STUDY)","volume":"60","author":"Th\u00e9venot","year":"2014","journal-title":"J Hepatol"},{"issue":"6","key":"10.1016\/j.jceh.2016.08.011_bib0470","doi-asserted-by":"crossref","first-page":"2305","DOI":"10.1002\/hep.25931","article-title":"Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis","volume":"56","author":"Arabi","year":"2012","journal-title":"Hepatology"},{"issue":"5","key":"10.1016\/j.jceh.2016.08.011_bib0475","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1002\/hep.28332","article-title":"An empirical broad spectrum antibiotic therapy in health-care-associated infections improves survival in patients with cirrhosis: a randomized trial","volume":"63","author":"Merli","year":"2016","journal-title":"Hepatology"},{"issue":"2","key":"10.1016\/j.jceh.2016.08.011_bib0480","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1097\/01.sla.0000171327.29262.e0","article-title":"Model for End-Stage Liver Disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis","volume":"242","author":"Northup","year":"2005","journal-title":"Ann Surg"},{"issue":"April","key":"10.1016\/j.jceh.2016.08.011_bib0485","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1053\/j.gastro.2007.01.040","article-title":"Risk factors for mortality after surgery in patients with cirrhosis","volume":"132","author":"Teh","year":"2007","journal-title":"Gastroenterology"},{"issue":"4","key":"10.1016\/j.jceh.2016.08.011_bib0490","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1016\/j.jhep.2012.03.037","article-title":"Assessment of risk for non-hepatic surgery in cirrhotic patients","volume":"57","author":"Bhangui","year":"2012","journal-title":"J Hepatol"}],"container-title":["Journal of Clinical and Experimental Hepatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0973688316303607?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0973688316303607?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T06:03:19Z","timestamp":1760853799000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0973688316303607"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,9]]},"references-count":49,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2016,9]]}},"alternative-id":["S0973688316303607"],"URL":"https:\/\/doi.org\/10.1016\/j.jceh.2016.08.011","relation":{},"ISSN":["0973-6883"],"issn-type":[{"value":"0973-6883","type":"print"}],"subject":[],"published":{"date-parts":[[2016,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Acute on Chronic Liver Failure\u2014What is in a \u2018Definition\u2019?","name":"articletitle","label":"Article Title"},{"value":"Journal of Clinical and Experimental Hepatology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jceh.2016.08.011","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2016 INASL.","name":"copyright","label":"Copyright"}]}}