Knowledge Portal
Acute-on-chronic liver failure
Acute-on-chronic liver failure (ACLF) is a rapidly evolving syndrome in which acute decompensation is accompanied by organ failure and a high short-term risk of death. Definitions differ between major international groups, so the framework being used should always be stated. In critical care, the practical priorities are to identify and treat precipitants, support failing organs, reassess trajectory frequently and involve a transplant centre early when appropriate.
Key information
Guidelines and position statements
Relevant clinical practice guidelines, practice guidance, consensus statements and position papers from professional bodies and expert groups.
EASL Clinical Practice Guidelines on acute-on-chronic liver failure
EASL · guideline · 2023
The European framework for ACLF recognition, organ support and transplant referral.
Open resource →Further context
Other useful resources
Selected review articles, practical explainers, expert discussions, reference sites and e-learning from established providers.
Management of the acute on chronic liver failure in the intensive care unit
Karvellas CJ, Gustot T, Fernandez J. Liver International. 2025;45(3):e15659.
The most directly ICU-focused overview in this selection, covering organ support, prognosis and transplantation.
Open resource →Acute-on-Chronic Liver Failure
Trebicka J, et al. Deutsches Ärzteblatt International. 2025;122(4):96–102.
A concise clinical overview that is useful for establishing definitions, diagnosis and broad management principles.
Open resource →Acute-on-chronic liver failure: pathophysiological mechanisms and clinical management
Sarin SK, et al. Nature Reviews Gastroenterology & Hepatology. 2026;23(5):411–431.
A current, comprehensive review that also explains how the major ACLF frameworks differ.
Open resource →ACLF: A Tipping Point in Chronic Liver Disease
AASLD Liver Fellow Network · clinical explainer · 2025
A readable introduction to ACLF definitions, precipitants and early management.
Open resource →Acute decompensation of chronic end-stage liver disease
Deranged Physiology · ICU revision chapter · updated 2025
A practical critical-care overview of the physiology and common organ complications.
Open resource →The Patient with Chronic Liver Disease
NHS England e-Learning for Healthcare · e-LA module
A structured anaesthesia and critical-care session on chronic liver failure presenting to intensive care.
Open resource →