Acute-on-Chronic Liver Failure Clinical Practice Guidelines (ACG, 2022)

American College of Gastroenterology

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

May 04, 2022

Guidelines on the management of acute-on-chronic liver failure were published on February 1, 2022, by the American College of Gastroenterology in the American Journal of Gastroenterology.[1]

In hospitalized patients with acute-on-chronic liver failure (ACLF), short-acting dexmedetomidine is suggested for sedation over other available agents to shorten time to extubation.

In patients with cirrhosis and stages 2 and 3 acute kidney injury (AKI), intravenous albumin and vasoconstrictors are suggested over albumin alone to improve creatinine levels.

In hospitalized patients with cirrhosis and hepatorenal syndrome–AKI (HRS-AKI) without high grade of ACLF or disease, terlipressin or norepinephrine is suggested to improve renal function.

In patients with cirrhosis and spontaneous bacterial peritonitis (SBP), albumin in addition to antibiotics is suggested to prevent AKI and subsequent organ failure.

In patients with cirrhosis and infections other than SBP, recommend against albumin to improve renal function or mortality.

In patients with cirrhosis who require invasive procedures, thromboelastography (TEG) or rotational TEG is suggested, as compared to INR, to more accurately assess transfusion needs.

In patients with severe alcohol-associated hepatitis (Maddrey discriminant function [MDF] ≥32; model for end-stage liver disease [MELD] score >20) in the absence of contraindications, prednisolone or prednisone (40 mg/day) orally is recommended to improve 28-day mortality.

For more information, see Acute Liver Failure.


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