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ACLF occurs in 30% of patients who need to be hospitalized. It mainly concerns patients with underlying cirrhosis, who rapidly progress to multi-organ failure (renal failure, hepatic encephalopathy, coagulopathy, liver failure characterized by a very sharp increase in bilirubin, respiratory failure). In 50% of patients there is no direct provoking factor. The pathogenesis is increased permeability of the gastrointestinal tract to bacterial toxins (due to a disturbed intestinal microbiome/virion, including direct alcohol toxicity). Acute or chronic liver failure is initially characterized by a cytokine storm, accompanied by cholestasis and severe jaundice, as in sepsis. Subsequently, immune paralysis develops, leading to bacterial infections and eventually multi-organ failure.

Patients with acute or chronic liver failure may also develop relative adrenal insufficiency (hepatorenal syndrome). The prognosis can be estimated using the CLIF scores. The complication has a mortality of approximately 60% after 6 weeks. There is no therapy yet.

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