Systemic Inflammation and Acute-on-Chronic Liver Failure: Too Much, Not Enough

Table 1

Definition and prognosis of ACLF.

Grade of ACLF	28-day mortality	90-day mortality
ACLF grade 1
(i) Single kidney failure	22.1	40.7
(ii) Single “non-kidney” organ failure with serum creatinine ranging from 1.5 mg/dl to 1.9 mg/dl and/or grade I or II hepatic encephalopathy
ACLF grade 2: Presence of 2 organ failures	32	52.3
ACLF grade 3: Presence ≥3 organ failures	76.7	79.1

Minimal organ failures defined by the modified Sequential Organ Failure Assessment (SOFA) score for patients with cirrhosis:
(i) Liver: bilirubin ≥ 12mg%
(ii) Kidney: creatinine ≥ 2.0mg%
(iii) Cerebral: hepatic encephalopathy ≥ grade 3
(iv) Coagulation: INR ≥ 2.5 or platelets < 20.000 per mm³
(v) Circulation: need of vasopressors
(vi) Lungs: PaO/FiO2 > 100