Acute-On-Chronic Liver Failure In Cirrhotic Patients
Acute-On-Chronic Liver Failure In Cirrhotic Patients
Cirrhosis is a condition characterized by diffuse fibrosis, severe disruption of the
 intrahepatic arterial and venous flow, portal hypertension and, ultimately, liver cell
 failure. Traditionally, cirrhosis has been dichotomised in compensated and decompensated, and
 the transition to decompensated cirrhosis happens when any of the following hallmarks occurs:
 presence of ascites, variceal haemorrhage and/ or hepatic encephalopathy (HE) . In Egypt, HCV
 is the main cause of liver cirrhosis followed by HBV
Cirrhosis is a condition characterized by diffuse fibrosis, severe disruption of the
 intrahepatic arterial and venous flow, portal hypertension and, ultimately, liver cell
 failure. Traditionally, cirrhosis has been dichotomised in compensated and decompensated, and
 the transition to decompensated cirrhosis happens when any of the following hallmarks occurs:
 presence of ascites, variceal haemorrhage and/ or hepatic encephalopathy (HE). In Egypt, HCV
 is the main cause of liver cirrhosis followed by HBV. Once cirrhosis transitions from the
 compensated to the decompensated stage, it is associated with short-term survival (3-5 years)
 . The concept of acute-on-chronic liver failure (ACLF) has been widely used to study patients
 who underwent artificial support therapies as a bridge to liver transplantation (LT). In
 2009, the Asian Pacific Association for the Study of the Liver (APASL) provided the first
 consensus on ACLF, defined as "an acute hepatic insult manifesting as jaundice and
 coagulopathy, complicated within 4 weeks by ascites and/or encephalopathy". In 2014, the
 definition was further expanded to include 'high 28-day mortality'. Therefore, acute on top
 of chronic liver failure (ACLF) is defined as a syndrome characterized by acute decompensated
 cirrhosis associated with failure of various organs and high short term mortality rate; based
 on CANONIC study which is a large scale prospective study, in which the kidneys were the most
 common affected organs, followed by liver, coagulation, the brain, circulation and the lungs.
 ACLF can occur in patients with chronic liver disease without cirrhosis (type A), with
 compensated cirrhosis (type B), and with decompensated cirrhosis (type C) .In many cases, a
 precipitating factor linked to the development of ACLF can be identified including alcohol
 intake, reactivation of HBV or acute hepatitis due to HAV or HEV, bacterial infection or GI
 hemorrhage. The CLIF-C OF score which consists of numbers and types of organ failures (OFs)
 including kidneys, liver, coagulation, the brain, circulation, and the lungs is associated
 with 28-day and 90-day mortality. Moreover, some specific organ dysfunction such as kidney
 dysfunction and moderate HE, when associated with single OF, was also associated with bad
 prognosis . On this background, diagnostic criteria of ACLF were established according to the
 presence, type and number of OFs.

 The severity of ACLF was graded into different stages according to the number of OFs on ACLF
 grade 1, grade 2 and grade 3 and mortality correlates with ACLF severity.

 To predict prognosis and mortality more accurately. developed CLIF-C-ACLF score which has a
 greater prognostic capability than CLIF-C- OF, It consists of the CLIF-C- OF combined with
 age and WBCs count. Few studies have addressed the patterns of acute on chronic liver failure
 in Egyptian cirrhotic patients . Therefore, we will conduct our study to shed
Inclusion Criteria:

 -  Cirrhotic patients whether compensated or decompensated with an acute decompensation
 of cirrhosis which is defined by the recent development of ascites, encephalopathy, GI
 haemorrhage, bacterial infection, or any combination of these

 Exclusion Criteria:

 -  no exclusion criteria