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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Cite this: Acute-on-Chronic Liver Failure Clinical Practice Guidelines (EASL, 2023) - Medscape - Aug 16, 2023.