Figure 7 Management algorithm for patients with ACLF Figure 7 | Management algorithm for patients with ACLF. Management of patients with ACLF includes identification of the acute hepatic insult and the specific therapy (if possible) that should be offered to ameliorate liver injury. Chronic liver disease includes patients without cirrhosis and with stable cirrhosis. Diagnosing cirrhosis often requires transjugular liver biopsy, but is not mandatory. The management strategy for those in liver failure, is primarily based upon the baseline MELD score and presence (or absence) and number of organ failures. Standard medical care (that is, nutrition, diuretics, antibiotics and intravenous albumin) is given upon hospital admission and is continued with assessments on day 4–7 (during the first week). Development or increase in the number of organ failures needs early or emergency liver transplantation. Organ support and bridging therapy (such as artificial liver support system, plasmapheresis) and regenerative therapy can be considered in selective cases with careful monitoring and a back-up liver transplantation plan. ACLF, acute-on-chronic liver disease; AIH, autoimmune hepatitis; DILI, drug-induced liver injury; MELD, model of end-stage liver disease; OF, organ failure. *Denotes a therapy that is not currently established as a standard treatment. Sarin, S. K. & Choudhury, A. (2016) Acute‑on‑chronic liver failure: terminology, mechanisms and management Nat. Rev. Gastroenterol. Hepatol. doi:10.1038/nrgastro.2015.219