How is ACLF grade defined by the EASL-CLIF Consortium?

ACLF is defined in cirrhosis with acute decompensation. Grade 1: 1 organ failure (if renal, alone); OR 1 non-renal organ failure with creatinine 1.5–1.9 mg/dL; OR 1 non-renal organ failure with grade 1–2 hepatic encephalopathy. Grade 2: 2 organ failures. Grade 3: ≥3 organ failures. 28-day mortality: Grade 1 ~22%, Grade 2 ~32%, Grade 3 ~77%. The CLIF-C ACLF score (continuous version) provides more granular prognostication for clinical trials.

What are the most common precipitating events for ACLF?

In European cohorts (CANONIC study), infection — particularly bacterial infections including spontaneous bacterial peritonitis, pneumonia, and urinary tract infections — accounts for ~33% of ACLF precipitants. Active alcohol use triggers ~25%. Non-hepatic surgery precipitates approximately 10%. In ~45% of cases, no specific precipitating event is identified. Hepatitis B reactivation is the most common precipitant in Asian cohorts. Recognizing and treating the precipitant is the primary therapeutic strategy alongside organ support.

Acute-on-Chronic Liver Failure (ACLF) Severity

Grade ACLF severity (Grade 1, 2, 3) using the EASL-CLIF Consortium Organ Failure Score, which assesses renal, hepatic, cerebral, coagulation, circulatory, and pulmonary failure.

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Acute-on-Chronic Liver Failure (ACLF) Severity

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Frequently Asked Questions

How is ACLF grade defined by the EASL-CLIF Consortium?

What are the most common precipitating events for ACLF?