Inflammasome and extrahepatic organ failure in acute-on-chronic liver failure

Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute deterioration of liver function in patients with pre-existent chronic liver disease together with organ failure (OF). Six organs have been defined: brain, circulation, coagulation, kidneys, lungs and liver. Consequently, it is associated with high short-term mortality (1). The prevalence of ACLF is around 30% among patients with end-stage cirrhosis hospitalized with acute decompensation (AD). Patients are dynamically classified as having ACLF according to the number of OFs (corresponding to three grades of severity), with an increased risk of short-term death. Mortality correlates better with the early clinical course of ACLF than with the initial grade at presentation, especially between the third and seventh day after diagnosis (2).