Knowledge Portal
Prognostication and ICU decisions
Prognosis in liver critical care is dynamic. Scores such as MELD, CLIF-C AD and CLIF-C ACLF describe populations and support repeated reassessment, but they do not make an individual ICU admission or treatment-limitation decision. Reversibility, precipitant, organ-failure trajectory, baseline function, frailty, transplant potential and the patient’s values all matter. When uncertainty is genuine, a time-limited trial of intensive care with predefined review points can be more honest than either automatic escalation or premature exclusion. Palliative care should run alongside active treatment when symptom burden or uncertainty is high.
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
Guidance on dynamic prognostication, ICU organ support, futility assessment and transplantation in ACLF.
Open resource →EASL position paper on palliative care in patients with advanced chronic liver disease
EASL · position paper · 2026
A contemporary framework for integrating palliative care with active hepatology and transplant care.
Open resource →Further context
Other useful resources
Selected review articles, practical explainers, expert discussions, reference sites and e-learning from established providers.
Review article: Evaluation and care of the critically ill patient with cirrhosis
Kosuta I, Premkumar M, Reddy KR. Alimentary Pharmacology & Therapeutics. 2024;59(12):1489–1509.
A broad ICU review integrating organ support, prognosis, transplant candidacy and goals of care.
Open resource →Prognosis algorithms for acute decompensation of cirrhosis and ACLF
Valainathan SR, Xie Q, Arroyo V, Rautou PE. Liver International. 2025;45(3):e15927.
A focused open-access guide to static and dynamic prognostic models and how they should inform clinical judgement.
Open resource →Palliative care in cirrhosis of the liver
Al-Moussally F, Tejada N, Khan S, et al. BMJ Supportive & Palliative Care. 2025;15(5):600–605.
A practical review of symptom burden, communication, advance care planning and concurrent palliative care.
Open resource →Staging and prognosis of chronic liver disease in ICU
Deranged Physiology · ICU revision chapter · updated 2025
A useful explanation of MELD, CLIF and other scores, with appropriate emphasis on their limitations.
Open resource →Acute-on-Chronic Liver Failure
Critical Care Reviews · curated review collection
A maintained set of free reviews on prognosis, ICU admission, treatment limitation and transplantation.
Open resource →