CASE 01•8–10 minutes•Cirrhosis · ACLF · ICU admission · Transplantation

Would you admit this patient to ICU?

A patient with cirrhosis is deteriorating on the ward. Work through escalation, organ failure and what the next few days might change.

For clinicians working in critical care, hepatology and acute medicine.

Weigh acute physiology, reversibility and baseline function when considering ICU admission.

Recognise organ failures using the EASL–CLIF definition of ACLF.

Use the subsequent clinical course to revisit prognosis, transplant options and goals of care.

Day 1 · Medical ward

The referral

Stage 1 of 5

“He has cirrhosis. Would ICU help?”

A 54-year-old man with alcohol-related cirrhosis is admitted with fever, cough and new confusion. Chest imaging shows right lower-lobe consolidation. He has ascites, but no active gastrointestinal bleeding.

Antibiotics have been started and initial fluid resuscitation reassessed. He remains hypotensive with poor peripheral perfusion and falling urine output. He is maintaining his own airway, there has been no witnessed aspiration, and SpO₂ is 95% on 2 L/min nasal oxygen. His condition is worsening on the ward.

MAP58 mmHg

Lactate5.4 mmol/L

Creatinine210 µmol/L (baseline 80)

Bilirubin230 µmol/L

INR2.0

EncephalopathyWest Haven grade II

Your decision

How should escalation be framed at this point?

Choose an approach to reveal the discussion and supporting evidence.

Educational content only. The case is fictional and does not replace local guidance, specialist advice or individual clinical judgement.

Clinical review: Dr Tom Dixon · 2026-09-28

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