{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:11:18Z","timestamp":1792613478698,"version":"4.5.0"},"reference-count":33,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Severe alcohol-associated hepatitis (SAH) is a complication of alcoholic liver disease associated with high mortality. Effective identification of factors predicting the course, outcome, and need for early liver transplantation (eLT) in patients with SAH is crucial. Acute-on-chronic liver failure (ACLF), a syndrome characterized by an acute decompensation of cirrhosis, failure of one or more organs, and high short-term mortality, can occur in SAH, and its impact on management, prognostication, and need for eLT should be clarified. Methods: This is a single-center, retrospective study of patients with SAH admitted to the ASST GOM Niguarda in Milan between April 2016 and May 2023. Results: One hundred patients were included. Median Maddrey\u2019s discriminant function (MDF) was 72.1 (IQR 51.6\u2013101.3), and the median model for end-stage liver disease\u2014sodium (MELD-Na) score was 28.5 (IQR 25.0\u201332.5). At presentation, 57 patients (57%) had ACLF 0\u20131 (54 ACLF 0\u2014no organ failure [OF] or single non-renal OF with serum creatinine &lt; 1.5 mg\/dl and no hepatic encephalopathy; 3 ACLF 1\u2014defined by the presence of at least renal failure or any other single OF if associated with renal dysfunction and\/or grade I\u2013II hepatic encephalopathy), and 43 patients (43%) had ACLF 2\u20133 (31 ACLF 2\u2014defined by the presence of two OFs, 12 ACLF 3\u2014defined by the presence of three or more OFs). In the latter group, circulatory failure was present in two (4.65%) and respiratory failure in three (6.98%). SAH was the only precipitating factor in 3 (100%) and 39 (90.7%) patients with ACLF 1 and ACLF 2\u20133, respectively, with infection being an associated factor in 5 (11.63%) and GI bleeding in 2 (4.65%) of subjects with ACLF 2\u20133. Non-response to medical treatment (MT) was significantly higher in patients with ACLF 2\u20133 (38\/43, 88.4%) than in those with ACLF 0\u20131 (25\/57, 43.8%). ACLF 2\u20133 was associated with a corresponding higher need for eLT (ACLF 2\u20133: 15\/43, 34.9% vs. ACLF 0\u20131: 10\/57, 17.54%%; p = 0.0474). ACLF status at presentation (ACLF 2\u20133 vs. ACLF 0\u20131) has a similar predictive accuracy of outcome (death or liver transplantation [LT]) to MELD-Na (as a 1-unit increase) (3.261 [1.999; 5.318], concordance index 0.702 vs. 1.154 [1.094; 1.217], concordance index 0.708). Conclusions: ACLF 2\u20133 is a frequent presentation of SAH, 43% of the cases. Given that most of these patients do not respond to MT (approximately 90%), fast-track evaluation for LT is advised for patients with a favorable psycho-social profile.<\/jats:p>","DOI":"10.3390\/jcm15187020","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T11:38:39Z","timestamp":1789040319000},"page":"7020","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acute-on-Chronic Liver Failure in Severe Alcohol-Associated Hepatitis: Impact on Management, Prognostication, and Urgency of Liver Transplantation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3890-5393","authenticated-orcid":false,"given":"Giovanni","family":"Perricone","sequence":"first","affiliation":[{"name":"Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Raffaella","family":"Vigan\u00f2","sequence":"additional","affiliation":[{"name":"Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Chiara","family":"Mazzarelli","sequence":"additional","affiliation":[{"name":"Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8262-0304","authenticated-orcid":false,"given":"Chiara","family":"Becchetti","sequence":"additional","affiliation":[{"name":"Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Giulia","family":"Dispinzieri","sequence":"additional","affiliation":[{"name":"Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Adelaide","family":"Panariello","sequence":"additional","affiliation":[{"name":"Mental Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Paola","family":"Prandoni","sequence":"additional","affiliation":[{"name":"Mental Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5774-3740","authenticated-orcid":false,"given":"Sara","family":"Conti","sequence":"additional","affiliation":[{"name":"Occupational Health Service, General Management, University of Milano-Bicocca, 20900 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5241-4473","authenticated-orcid":false,"given":"Paolo Angelo","family":"Cortesi","sequence":"additional","affiliation":[{"name":"Research Centre on Public Health (CESP), University of Milano-Bicocca, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Mario","family":"Camozzi","sequence":"additional","affiliation":[{"name":"Pathology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Gianpaola","family":"Monti","sequence":"additional","affiliation":[{"name":"Transplant Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Andrea","family":"Lauterio","sequence":"additional","affiliation":[{"name":"General Surgery and Transplantation Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Stefano","family":"Di Sandro","sequence":"additional","affiliation":[{"name":"General Surgery and Transplantation Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Luca Saverio","family":"Belli","sequence":"additional","affiliation":[{"name":"Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/j.jhep.2018.05.001","article-title":"Grand Rounds: Alcoholic Hepatitis","volume":"69","author":"Singal","year":"2018","journal-title":"J. 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