Treatment strategies in both acute decompensation (AD) and acute-on-chronic liver failure (ACLF)
| Characteristics | Treatment |
|---|---|
| Underlying cause and acute triggering factors | Cause-specific treatment |
| Infection | Antibacterial, antiviral, antifungal |
| Coagulopathy | LMWH, DOACs, warfarin, platelet replacement, cryoprecipitate, FFP, 4-FPCC |
| Renal Failure | Fluid resuscitation, withdraw diuretics, albumin, vasoconstrictors, RRT |
| Hepatic encephalopathy | Lactulose/polyethylene glycol, L-ornithine L-aspartate/ornithine phenylacetate, rifaximin*, albumin* |
| Cardiovascular failure | Fluid resuscitation, albumin, vasopressors (norepinephrine, vasopressin), hydrocortisone |
| Respiratory failure | Pulmonary vasodilators (inhaled NO, epoprostenol), NIV, high-flow oxygen, MV |
| Sarcopenia | Nutrition |
| Liver failure | Liver transplantation |
| Bridge treatments | Plasma exchange, single-pass albumin dialysis, MARS, Prometheus |
| Next generation treatments | G-CSF, MSC transplantation, TLR-4 inhibition, TAK-242, recombinant alkaline phosphatase, gDNA, emricasan, mitofusin-2, oxysterol sulfates, statin, NAC |
* The roles of these treatments are unclear. DOACs: direct-acting anticoagulants; FFP: fresh frozen plasma; 4-FPCC: four-factor prothrombin complex concentrate; G-CSF: granulocyte colony stimulating factor; LMWH: low molecule weighed heparin; MARS: the molecular adsorbent recirculation system; MSC: mesenchymal stem cell; MV: mechanical ventilation; NAC: N-acetylcysteine; NIV: non-invasive ventilation; NO: nitric oxide; RRT: renal replacement therapy; TLR-4: Toll-like receptor 4