Cirrhosis or acute-on-chronic liver failure: definition and classification

Cirrosis hepática o falla hepática crónica agudizada: definición y clasificación

Cirrhosis is considered the chronic and irreversible stage of liver injury. Its etiology is diverse and includes causes such as viral infection, toxic substances such as alcohol, drugs, autoimmune conditions and others. Decompensated cirrhosis is a consequence of pathophysiological changes that occur over time, such as ascites, spontaneous bacterial peritonitis, gastrointestinal hemorrhage, hepatorenal syndrome, hepatic encephalopathy or portopulmonary hypertension, while acute-on-chronic liver failure (ACLF) should be differentiated from cirrhosis, for it is a multiple organ failure of rapid clinical course, usually in patients in the  intensive care unit, often secondary to precipitating events such as shock. The clinician must identify the difference between the two for an appropriate approach and evaluation. The current suitable method to stage this entity is the CLIFF SOFA score, which evaluates 28-day and 90-day mortality risk factors, allowing appropriate interventions in each case.

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