Interguideline differences in ACLF definition
| Characteristics | APASL | EASL-CLIF | NACSELD |
|---|---|---|---|
| Definition | Acute jaundice and coagulopathy, followed by ascites ± HE within 4 weeks | Specified criteria using CLIF-OF score for OF, 28-day mortality rate > 15% | ≥ 2 extrahepatic OF (circulation, kidney, cerebral, respiratory) |
| Organ failure | AARC score | CLIF-C OF score | MELD score |
| Liver | T. Bil ≥ 5 mg/dL + INR ≥ 1.5 | T. Bil ≥ 12 mg/dL | - |
| Kidney | AKI Network criteria | Cr ≥ 2 or RRT | RRT |
| Cerebral | HE 3–4 | HE 3–4 | HE 3–4 |
| Coagulopathy | - | INR ≥ 2.5 | - |
| Circulatory | - | Need to use of vasopressor (terlipressin and/or catecholamines) | Shock (MAP < 60 mmHg or > 40 mmHg systolic BP reduction from baseline) |
| Respiratory | - | PaO2/FiO2 ≤ 200 or sPO2/FiO2 ≤ 214 or need for mechanical ventilation (≤ 300 for ALI or ≤ 200 for ARDS) | Need for mechanical ventilation |
| Inclusion criteria | Undiagnosed or diagnosed chronic liver disease, including cirrhosis | Cirrhosis ± prior decompensation | Inpatient cirrhosis (± prior decompensation) with infection at or during admission |
| Exclusion criteria | Prior decompansationBacterial infectionGI bleedingHCC | HCC with beyond Milan criteriaReceiving immunosuppressive treatmentHIVSevere chronic extrahepatic disease | Outpatients with infectionCirrhosis without infectionHIVPrior organ transplantationDisseminated malignancies |
| Time frame | 4 weeks | 4–12 weeks | Not defined |
| Major organ failure | Hepatic | Hepatic + extrahepatic | Extrahepatic |
| Time of diagnosis | Early | Moderate | Too late |
AARC: APASL-ACLF research consortium; ACLF: acute-on-chronic liver failure; AKI: acute kidney injury; ALI: acute lung injury; APASL: Asian Pacific Association for the Study of the Liver; ARDS: adult respiratory distress syndrome; Cr: creatinine; EASL-CLIF: European Association for the Study of the Liver-Chronic Liver Failure; FiO2: fraction of inspired oxygen; GI: gastrointestinal; HCC: hepatocelluler carcinoma; HE: hepatic encephalopathy (West-Haven criteria); HIV: human immunodeficiency virus; INR: international normalized ratio; MAP: mean arterial pressure; MELD: Model of the End Liver Disease; NACSELD: North American Consortium for the Study of End-Stage Liver Disease; OF: organ failure; PaO2: partial pressure of arterial oxygen; RRT: renal replacement therapy; BP: blood pressure; sPO2: pulse oximetric saturation; T.Bil: total bilirubin