Acute-on-Chronic Liver Failure Clinical Practice Guidelines (EASL, 2023)

European Association for the Study of the Liver

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.

August 16, 2023

Clinical guidelines on the management of acute-on-chronic liver failure (ACLF) were published in June 2023 by the European Association for the Study of the Liver, in the Journal of Hepatology.[1]

Consider liver transplantation for patients with hepatitis B virus (HBV)–related ACLF if they have a severe presentation (eg, Model for End-Stage Liver Disease [MELD] score >30; ACLF-2 or -3) despite early initiation of antiviral therapy, particularly if an early virologic response is absent (<2-log reduction) and clinical improvement is lacking.

Patients with autoimmune hepatitis (AIH) and ACLF who receive corticosteroids should undergo close surveillance for infection and strict monitoring of the corticosteroid treatment’s efficacy.

Patients with ACLF who have suspected infection should undergo empirical antibiotic treatment that accounts for the local epidemiology of bacterial infections and antibiotic resistance risk factors.

Detailed nutritional status assessment in patients at risk for malnutrition should include: (1) a bedside energy requirement evaluation administered by a dietitian or by a medical nutrition expert; (2) a sarcopenia assessment employing the skeletal muscle index or psoas muscle area at the third lumbar vertebra, if the patient has undergone a computed tomography (CT) scan; and (3) a liver frailty index measurement (in patients who are not bedbound).

In all patients with severe ACLF (ACLF-2 or -3), propose an early assessment for liver transplantation.

For more information, please go to Acute Liver Failure.


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