Acute- on- chronic liver failure: from pathophysiology to clinical practice

Acute- on- chronic liver failure ( ACLF) is a clinical syndrome with rapid liver function decompensation as a result of chronic liver disease. As a clinical entity characterized by rapid progression, requirement for multiple organ support therapy, and a short- and medium- term mortality up to more than 50%, it has received wide attention in the past decade. Due to its complex pathogenesis, no consensus has been reached on the definition of ACLF. Therefore, starting with our current understanding of this disease, we reviewed how ACLF came to be increasingly recognized in the medical community and what differences exist in the understanding of the ACLF concept between China and other countries, analyzed important pathophysiological changes and characteristics of ACLF, and proposed new therapeutic concepts and methods based on the pathophysiology. Taken together, under the guidance of the pathophysiology of the disease, clinical management of ACLF will achieve better therapeutic effect and prognosis in future.