Answers
What is ACLF (acute-on-chronic liver failure)?
Short answer
ACLF, or acute-on-chronic liver failure, is a sudden and severe worsening of liver function in someone who already has chronic liver disease. It is often triggered by alcohol, a hepatitis flare, an infection or bleeding. It can lead to failure of other organs such as the kidneys and brain, and needs urgent hospital care, often in an intensive care unit.
What it means
In ACLF, a person with long-standing liver disease, such as fatty liver, alcohol-related liver disease or hepatitis B or C, with or without cirrhosis, suffers a new injury to the liver. Within days to weeks, jaundice deepens and blood clotting worsens. Fluid may build up in the belly, the brain may be affected (hepatic encephalopathy) and the kidneys may fail.
Asian and European liver societies define ACLF slightly differently, but both describe a sudden, serious worsening with a high risk to life that needs prompt specialist care.
Common triggers
Sometimes no clear trigger is found.
- Heavy drinking and alcoholic hepatitis
- A flare of hepatitis B, especially after stopping hepatitis B medicines or during chemotherapy
- Hepatitis A or E infection on top of existing liver disease
- Bacterial infections, for example in the belly fluid, urine or lungs
- Bleeding from varices
- Some medicines and unregulated herbal supplements
Warning signs
These are emergencies. Go to the nearest hospital emergency department or call 112.
- Jaundice that deepens quickly
- Confusion, unusual sleepiness or change in behaviour
- Fever, or a belly that keeps swelling
- Passing very little urine
- Vomiting blood or black stools
Treatment
- Care in hospital, often in an intensive care unit
- Finding and treating the trigger: antiviral medicines for hepatitis B, antibiotics for infection, stopping bleeding, stopping alcohol, and steroids for selected cases of alcoholic hepatitis
- Supporting the organs that are failing, with fluids, albumin, kidney support and breathing support when needed
- Careful nutrition
- Early assessment for liver transplantation in suitable patients, which can be life-saving
Outlook and prevention
ACLF is serious, and the outlook depends on how many organs are affected and how quickly the trigger can be controlled. Some people recover well, back to their earlier state, when treatment starts early.
- Stop alcohol completely if you have liver disease
- Take hepatitis B medicines regularly and never stop them without your doctor's advice
- Get vaccinated against hepatitis A and B if you are not immune
- Avoid unprescribed herbal and 'detox' products
- Keep regular check-ups if you have cirrhosis, and seek help early for fever or new symptoms
Diet during and after ACLF
Eat more
- Small meals every 2 to 3 hours and a late evening snack, so the body does not break down muscle overnight
- Enough protein from dal, curd, paneer, eggs, fish or chicken
- Freshly cooked, hot food and boiled or filtered water
Cut down
- Alcohol, completely
- Salt, if there is fluid in the belly or swollen legs: no extra salt, pickles, papad or namkeen
- Raw or undercooked eggs and meat, cut fruit and street food, which can carry infections
Good to know
- In hospital, feeding through a soft tube is common when a patient cannot eat enough.
- Water is restricted only if blood sodium is low and your doctor advises it.
Common questions
Is ACLF the same as cirrhosis?
No. Cirrhosis is long-term scarring of the liver. ACLF is a sudden, severe worsening on top of an existing liver disease, often with failure of other organs such as the kidneys or brain.
Can a person recover from ACLF?
Some people do, especially when the trigger is found and treated early and fewer organs are affected. Others need a liver transplant, so early assessment at a transplant centre matters.
How can ACLF be prevented in someone with liver disease?
Stop alcohol, never stop hepatitis B medicines on your own, get vaccinated against hepatitis A and B, avoid unprescribed herbal products, and see a doctor early for fever, jaundice or confusion.