Home / Trials and Studies/ Trial or Study

Acute-on-chronic liver failure in Canadian Intensive Care Units: A period prevalence study

Principal Investigator(s):

Constantine Karvellas

View publication Acute-on-chronic liver failure: Objective admission and support criteria in the intensive care unit

Although the majority of cirrhotic patients can be managed in a non-critical care environment, acute decompensation or the development of ACLF may necessitate transfer to an ICU setting for more intensive support. Complications of variceal bleeding, HE, HRS, and respiratory, renal, and cardiovascular failures, often require critical care management in the ICU. This is especially true in patients who are LT candidates, where intensive management can serve as a bridge to transplantation. However, frequent reassessment and utilisation of prognostic scores such as the CLIF-C ACLF score are required to identify patients who will not benefit from continued intensive care therapies, particularly for patients who are not LT candidates. LT candidacy needs to be evaluated early on. For patients who are not LT candidates, if clinical improvement is not seen within 48 to 72 hours post-ICU admission, serious consideration should be given to palliation as opposed to continued aggressive ICU management. For those patients who are LT candidates continued aggressive therapy may allow bridging to LT.