Pathogenesis of Acute-on-Chronic Liver Failure in Patients With Infection

Acute‐on‐chronic liver failure (ACLF) can develop in patients with cirrhosis both at the compensated and decompensated stages of liver disease (Fig. 1). The clinical symptoms of ACLF include acute liver decompensation, organ failure (or multiorgan failure), and increased short‐term mortality.1 The triggers for ACLF could be different events including infections, gastrointestinal bleeding, alcohol binge, large‐volume paracentesis, transjugular intrahepatic portosystemic shunt, and surgery, although the precipitating factor cannot be identified in some cases of ACLF.2 Most studies found infection as the most frequent cause of ACLF. The CANONIC study reported bacterial infection in 32.6% of 303 cases, whereas Shi et al. found 27.9% of 404 cases of ACLS linked to bacterial infection.3, 11 In the latter study from Asia, hepatitis B virus exacerbation caused ACLD in 35.8% of reported ACLS cases.