1. Figure 2 The concept of the hepatic reserve and ACLF
Figure 2 | The concept of the hepatic reserve and ACLF. This model describes the outcome of an acute insult to the liver depending upon the hepatic reserve. The hepatic reserve is markedly reduced in patients with ACLF and much lower in those with decompensated cirrhosis. After acute insult or injury, the condition of a patient with ACLF is likely to rapidly deteriorate and in the first 1–2 weeks after injury onset, the patient could also develop sepsis. This intervening period is a therapeutic 'golden window', in which there are opportunities to ameliorate the acute injury and modulate the patient's immune response to prevent the development of sepsis, and supplement liver regeneration to reverse the decline towards multiorgan failure and death. A progressive downhill course often occurs in a patient with decompensated cirrhosis compared with ACLF. After mitigating the acute injury, spontaneous recovery is more likely in those with ACLF than decompensated cirrhosis because of a higher baseline hepatic reserve. Liver transplantation should preferably be done before the onset of multiorgan failure to achieve good outcomes. ACLF, acute-on-chronic liver failure; DC, decompensated cirrhosis.
Sarin, S. K. & Choudhury, A. (2016) Acute‑on‑chronic liver failure: terminology, mechanisms and management
Nat. Rev. Gastroenterol. Hepatol. doi: /nrgastro