Research
Evidence worth finding again
Detailed walkthroughs of selected new studies, alongside a concise, topic-led collection of the papers, guidelines and reviews that have shaped liver critical care.
New evidence
Latest Evidence Deep Dive
Detailed study walkthrough · newest first
ACLF
Therapeutic plasma exchange in ACLF: what the randomised trial found
Swaroop and colleagues randomised 194 adults with ACLF to therapeutic plasma exchange plus standard medical therapy or standard therapy alone. This Evidence Deep Dive examines the study population, treatment protocol, 28- and 90-day outcomes, and the questions raised by the difference between early and later survival.
Hepatology30 Mar 2026
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Essential reading
Key papers
A concise, topic-led collection of landmark studies, guidelines and reviews. Links open the original source.
ACLF
- Therapeutic plasma exchange improves short-term survival in patients with acute-on-chronic liver failure: a randomized controlled trial ↗
Swaroop S, Biswas S, Aggarwal A, et al.
Hepatology30 Mar 2026Original research
- Factors Associated with Survival of Patients With Severe Acute-On-Chronic Liver Failure Before and After Liver Transplantation ↗
Sundaram V, et al.
Gastroenterology1 Apr 2019Original research
- Diagnosis and management of acute kidney injury in patients with cirrhosis: Revised consensus recommendations of the International Club of Ascites ↗
Angeli P, et al.
Journal of Hepatology1 Apr 2015Guideline or consensus
- Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL): an update ↗
Sarin SK, et al.
Hepatology International1 Jul 2019Guideline or consensus
- Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis ↗
Gustot T, et al.
Hepatology1 Jul 2015Landmark study
- Granulocyte-colony stimulating factor (G-CSF) to treat acute-on-chronic liver failure: A multicenter randomized trial (GRAFT study) ↗
Engelmann C, et al.
Journal of Hepatology1 Dec 2021Landmark study
- Liver transplantation for critically ill cirrhotic patients: Stratifying utility based on pretransplant factors ↗
Artzner T, et al.
American Journal of Transplantation1 Sept 2020Original research
- Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis ↗
Moreau R, et al.
Gastroenterology1 Jun 2013Landmark study
- The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology ↗
Trebicka J, et al.
Journal of Hepatology1 Oct 2020Landmark study
- EASL Clinical Practice Guidelines on acute-on-chronic liver failure ↗
European Association for the Study of the Liver
Journal of Hepatology1 Aug 2023Guideline or consensus
- AASLD Practice Guidance on Acute-on-chronic liver failure and the management of critically ill patients with cirrhosis ↗
Karvellas CJ, et al.
Hepatology1 Jun 2024Guideline or consensus
- Liver transplantation in the most severely ill cirrhotic patients: A multicenter study in acute-on-chronic liver failure grade 3 ↗
Artru F, et al.
Journal of Hepatology1 Oct 2017Landmark study
- Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: Results of the ELITA/EF-CLIF collaborative study (ECLIS) ↗
Belli LS, et al.
Journal of Hepatology1 Sept 2021Landmark study
- Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure: the RELIEF trial ↗
Bañares R, et al.
Hepatology1 Mar 2013Landmark study
- Effects of fractionated plasma separation and adsorption on survival in patients with acute-on-chronic liver failure ↗
Kribben A, et al.
Gastroenterology1 Apr 2012Landmark study
- Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting ↗
Nadim MK, et al.
Journal of Hepatology1 Jul 2024Guideline or consensus
- Terlipressin Is Superior to Noradrenaline in the Management of Acute Kidney Injury in Acute on Chronic Liver Failure ↗
Arora V, et al.
Hepatology1 Feb 2020Landmark study
- Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide ↗
Piano S, et al.
Gastroenterology1 Apr 2019Original research
- Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe ↗
Fernández J, et al.
Journal of Hepatology1 Mar 2019Original research
- Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure ↗
Jalan R, et al.
Journal of Hepatology1 Nov 2014Landmark study
- Validation of CLIF-C ACLF score to define a threshold for futility of intensive care support for patients with acute-on-chronic liver failure ↗
Engelmann C, et al.
Critical Care10 Oct 2018Original research
Cirrhosis in critical care
- AASLD Practice Guidance on risk stratification and management of portal hypertension and varices in cirrhosis ↗
Kaplan DE, et al.
Hepatology1 May 2024Guideline or consensus
- MELD 3.0: The Model for End-Stage Liver Disease Updated for the Modern Era ↗
Kim WR, et al.
Gastroenterology1 Dec 2021Landmark study
- Diagnosis and management of acute kidney injury in patients with cirrhosis: Revised consensus recommendations of the International Club of Ascites ↗
Angeli P, et al.
Journal of Hepatology1 Apr 2015Guideline or consensus
- Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis ↗
Gustot T, et al.
Hepatology1 Jul 2015Landmark study
- β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial ↗
Villanueva C, et al.
The Lancet20 Apr 2019Landmark study
- Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury ↗
Belcher JM, et al.
Hepatology1 Aug 2014Original research
- Esophageal balloon tamponade versus esophageal stent in controlling acute refractory variceal bleeding: A multicenter randomized, controlled trial ↗
Escorsell A, et al.
Hepatology1 Jun 2016Landmark study
- Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis ↗
Moreau R, et al.
Gastroenterology1 Jun 2013Landmark study
- The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology ↗
Trebicka J, et al.
Journal of Hepatology1 Oct 2020Landmark study
- EASL Clinical Practice Guidelines on acute-on-chronic liver failure ↗
European Association for the Study of the Liver
Journal of Hepatology1 Aug 2023Guideline or consensus
- AASLD Practice Guidance on Acute-on-chronic liver failure and the management of critically ill patients with cirrhosis ↗
Karvellas CJ, et al.
Hepatology1 Jun 2024Guideline or consensus
- A Randomized Trial of Albumin Infusions in Hospitalized Patients with Cirrhosis ↗
China L, et al.
New England Journal of Medicine4 Mar 2021Landmark study
- Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting ↗
Nadim MK, et al.
Journal of Hepatology1 Jul 2024Guideline or consensus
- Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome ↗
Wong F, et al.
New England Journal of Medicine4 Mar 2021Landmark study
- Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis ↗
Sort P, et al.
New England Journal of Medicine5 Aug 1999Landmark study
- Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide ↗
Piano S, et al.
Gastroenterology1 Apr 2019Original research
- Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe ↗
Fernández J, et al.
Journal of Hepatology1 Mar 2019Original research
- Baveno VII - Renewing consensus in portal hypertension ↗
de Franchis R, et al.
Journal of Hepatology1 Apr 2022Guideline or consensus
- Early use of TIPS in patients with cirrhosis and variceal bleeding ↗
García-Pagán JC, et al.
New England Journal of Medicine24 Jun 2010Landmark study
- Transfusion strategies for acute upper gastrointestinal bleeding ↗
Villanueva C, et al.
New England Journal of Medicine3 Jan 2013Landmark study
- Thrombelastography-guided blood product use before invasive procedures in cirrhosis with severe coagulopathy: A randomized, controlled trial ↗
De Pietri L, et al.
Hepatology1 Feb 2016Landmark study
- Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences ↗
Lisman T, Porte RJ
Blood12 Aug 2010Review
- A model to predict survival in patients with end-stage liver disease ↗
Kamath PS, et al.
Hepatology1 Feb 2001Landmark study
- The Royal Free Hospital score: a calibrated prognostic model for patients with cirrhosis admitted to intensive care unit. Comparison with current models and CLIF-SOFA score ↗
Theocharidou E, et al.
American Journal of Gastroenterology1 Apr 2014Landmark study
- Rifaximin treatment in hepatic encephalopathy ↗
Bass NM, et al.
New England Journal of Medicine25 Mar 2010Landmark study
Alcohol-associated hepatitis
Encephalopathy and cerebral complications
Transplantation and peri-transplant critical care
- Therapeutic plasma exchange improves short-term survival in patients with acute-on-chronic liver failure: a randomized controlled trial ↗
Swaroop S, Biswas S, Aggarwal A, et al.
Hepatology30 Mar 2026Original research
- MELD 3.0: The Model for End-Stage Liver Disease Updated for the Modern Era ↗
Kim WR, et al.
Gastroenterology1 Dec 2021Landmark study
- Outcomes of Early Liver Transplantation for Patients With Severe Alcoholic Hepatitis ↗
Lee BP, et al.
Gastroenterology1 Aug 2018Landmark study
- Factors Associated with Survival of Patients With Severe Acute-On-Chronic Liver Failure Before and After Liver Transplantation ↗
Sundaram V, et al.
Gastroenterology1 Apr 2019Original research
- Liver transplantation for critically ill cirrhotic patients: Stratifying utility based on pretransplant factors ↗
Artzner T, et al.
American Journal of Transplantation1 Sept 2020Original research
- Acute Liver Failure Guidelines ↗
Shingina A, et al.
American Journal of Gastroenterology1 Jul 2023Guideline or consensus
- EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure ↗
European Association for the Study of the Liver
Journal of Hepatology1 May 2017Guideline or consensus
- Liver transplantation in the most severely ill cirrhotic patients: A multicenter study in acute-on-chronic liver failure grade 3 ↗
Artru F, et al.
Journal of Hepatology1 Oct 2017Landmark study
- Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: Results of the ELITA/EF-CLIF collaborative study (ECLIS) ↗
Belli LS, et al.
Journal of Hepatology1 Sept 2021Landmark study
- Early liver transplantation for severe alcoholic hepatitis ↗
Mathurin P, et al.
New England Journal of Medicine10 Nov 2011Landmark study
- A model to predict survival in patients with end-stage liver disease ↗
Kamath PS, et al.
Hepatology1 Feb 2001Landmark study
- Elective liver transplant list mortality: development of a United Kingdom end-stage liver disease score ↗
Barber K, et al.
Transplantation27 Aug 2011Landmark study
Organ support
- Therapeutic plasma exchange improves short-term survival in patients with acute-on-chronic liver failure: a randomized controlled trial ↗
Swaroop S, Biswas S, Aggarwal A, et al.
Hepatology30 Mar 2026Original research
- Acute Liver Failure Guidelines ↗
Shingina A, et al.
American Journal of Gastroenterology1 Jul 2023Guideline or consensus
- High-volume plasma exchange in patients with acute liver failure: An open randomised controlled trial ↗
Larsen FS, et al.
Journal of Hepatology1 Jan 2016Landmark study
- AASLD Practice Guidance on Acute-on-chronic liver failure and the management of critically ill patients with cirrhosis ↗
Karvellas CJ, et al.
Hepatology1 Jun 2024Guideline or consensus
- Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure: the RELIEF trial ↗
Bañares R, et al.
Hepatology1 Mar 2013Landmark study
- Effects of fractionated plasma separation and adsorption on survival in patients with acute-on-chronic liver failure ↗
Kribben A, et al.
Gastroenterology1 Apr 2012Landmark study
- Continuous renal replacement therapy is associated with reduced serum ammonia levels and mortality in acute liver failure ↗
Cardoso FS, et al.
Hepatology1 Feb 2018Original research
- Validation of CLIF-C ACLF score to define a threshold for futility of intensive care support for patients with acute-on-chronic liver failure ↗
Engelmann C, et al.
Critical Care10 Oct 2018Original research
Haemostasis and thrombosis
Portal hypertension and variceal bleeding
- AASLD Practice Guidance on risk stratification and management of portal hypertension and varices in cirrhosis ↗
Kaplan DE, et al.
Hepatology1 May 2024Guideline or consensus
- β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial ↗
Villanueva C, et al.
The Lancet20 Apr 2019Landmark study
- Esophageal balloon tamponade versus esophageal stent in controlling acute refractory variceal bleeding: A multicenter randomized, controlled trial ↗
Escorsell A, et al.
Hepatology1 Jun 2016Landmark study
- Baveno VII - Renewing consensus in portal hypertension ↗
de Franchis R, et al.
Journal of Hepatology1 Apr 2022Guideline or consensus
- Early use of TIPS in patients with cirrhosis and variceal bleeding ↗
García-Pagán JC, et al.
New England Journal of Medicine24 Jun 2010Landmark study
- Transfusion strategies for acute upper gastrointestinal bleeding ↗
Villanueva C, et al.
New England Journal of Medicine3 Jan 2013Landmark study
Circulatory failure
- Therapeutic plasma exchange improves short-term survival in patients with acute-on-chronic liver failure: a randomized controlled trial ↗
Swaroop S, Biswas S, Aggarwal A, et al.
Hepatology30 Mar 2026Original research
- β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial ↗
Villanueva C, et al.
The Lancet20 Apr 2019Landmark study
- A Randomized Trial of Albumin Infusions in Hospitalized Patients with Cirrhosis ↗
China L, et al.
New England Journal of Medicine4 Mar 2021Landmark study
- Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome ↗
Wong F, et al.
New England Journal of Medicine4 Mar 2021Landmark study
- Terlipressin Is Superior to Noradrenaline in the Management of Acute Kidney Injury in Acute on Chronic Liver Failure ↗
Arora V, et al.
Hepatology1 Feb 2020Landmark study
- Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis ↗
Sort P, et al.
New England Journal of Medicine5 Aug 1999Landmark study
Post-hepatectomy liver failure
Prognostication, phenotyping and research methods
- MELD 3.0: The Model for End-Stage Liver Disease Updated for the Modern Era ↗
Kim WR, et al.
Gastroenterology1 Dec 2021Landmark study
- Factors Associated with Survival of Patients With Severe Acute-On-Chronic Liver Failure Before and After Liver Transplantation ↗
Sundaram V, et al.
Gastroenterology1 Apr 2019Original research
- Arterial ammonia and clinical risk factors for encephalopathy and intracranial hypertension in acute liver failure ↗
Bernal W, et al.
Hepatology1 Dec 2007Landmark study
- Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL): an update ↗
Sarin SK, et al.
Hepatology International1 Jul 2019Guideline or consensus
- Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis ↗
Gustot T, et al.
Hepatology1 Jul 2015Landmark study
- Liver transplantation for critically ill cirrhotic patients: Stratifying utility based on pretransplant factors ↗
Artzner T, et al.
American Journal of Transplantation1 Sept 2020Original research
- Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis ↗
Moreau R, et al.
Gastroenterology1 Jun 2013Landmark study
- The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology ↗
Trebicka J, et al.
Journal of Hepatology1 Oct 2020Landmark study
- Early indicators of prognosis in fulminant hepatic failure ↗
O'Grady JG, et al.
Gastroenterology1 Aug 1989Landmark study
- Liver transplantation in the most severely ill cirrhotic patients: A multicenter study in acute-on-chronic liver failure grade 3 ↗
Artru F, et al.
Journal of Hepatology1 Oct 2017Landmark study
- Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: Results of the ELITA/EF-CLIF collaborative study (ECLIS) ↗
Belli LS, et al.
Journal of Hepatology1 Sept 2021Landmark study
- Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS) ↗
Rahbari NN, et al.
Surgery1 May 2011Guideline or consensus
- The "50-50 criteria" on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy ↗
Balzan S, et al.
Annals of Surgery1 Dec 2005Landmark study
- Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy ↗
Mullen JT, et al.
Journal of the American College of Surgeons1 May 2007Landmark study
- A model to predict survival in patients with end-stage liver disease ↗
Kamath PS, et al.
Hepatology1 Feb 2001Landmark study
- Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure ↗
Jalan R, et al.
Journal of Hepatology1 Nov 2014Landmark study
- The Royal Free Hospital score: a calibrated prognostic model for patients with cirrhosis admitted to intensive care unit. Comparison with current models and CLIF-SOFA score ↗
Theocharidou E, et al.
American Journal of Gastroenterology1 Apr 2014Landmark study
- Elective liver transplant list mortality: development of a United Kingdom end-stage liver disease score ↗
Barber K, et al.
Transplantation27 Aug 2011Landmark study
- Validation of CLIF-C ACLF score to define a threshold for futility of intensive care support for patients with acute-on-chronic liver failure ↗
Engelmann C, et al.
Critical Care10 Oct 2018Original research
- The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids ↗
Louvet A, et al.
Hepatology1 Jun 2007Landmark study