**4. Acute on chronic liver failure**

The development of acute liver failure on chronic failure (ACLF) occurs at any stage of the spectrum of chronic liver disease without cirrhosis or with compensated or decompensated liver cirrhosis [6], in which there are one or several precipitating

*Artificial Liver Support Systems DOI: http://dx.doi.org/10.5772/intechopen.109843*

#### **Figure 2.**

 *In the spectrum of chronic liver disease without cirrhosis or with compensated or decompensated liver cirrhosis, the clinical condition that favors exposure to a hepatic or extrahepatic precipitant generates an inflammatory response that induces the development of multiple organ failure.* 

events in the liver (alcohol ingestion, DILI, hepatitis, hepatic ischemia, liver surgery) or extrahepatic (acute bacterial infection, paracentesis without albumin, major surgery), which cause the development of multiple organ failure with the increased mortality between 28 and 90 days ( **Figure 2** ) [ 7 ].

 There is no universal definition, there are at least four consensuses that define it and the prevalence differs from continent to continent, in USA 10, EU 20.1, ASIA 5.1 cases per 1000 person-years [ 8 ].

The most agreed definitions of ACLF are mentioned below: ( **Table 2** ) [ 7 ],

 The severity of ACLF is measured by the degree of organic dysfunction through the CLIF-SOFA score in different cohorts of three subjects (CANONIC, PREDICT, KACLIF, COSSH, MAHMUD, HERNAEZ) showing us that the analytical alteration


 *Asian Pacific Association for the Study of the Liver (APASL), European Association for the Study of Chronic Liver Failure (EASL-Clif), North American Consortium for the Study of End-Stage Liver Disease's definition of acute-onchronic liver failure, and World Gastroenterology Organization (WGO).* 

#### **Table 2.**

 *Characteristics of definitions of ACLF developed by four different consortia.* 

is significant insofar as to the presence of leukocytosis, PCR, increases in TNF alpha, and IL-8 in statistically significant values in patients with ACLF when compared with decompensated or compensated cirrhosis. Likewise, it is observed that transplantfree mortality is higher in patients with ACLF [8].
