*Review* **Acute-on-Chronic Liver Failure in Cirrhosis**

**Carmine Gambino, Salvatore Piano \* and Paolo Angeli**

Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; carmine.gabriele.gambino@gmail.com (C.G.); pangeli@unipd.it (P.A.) **\*** Correspondence: salvatorepiano@gmail.com

**Abstract:** Acute-on-chronic liver failure (ACLF) is a syndrome that develops in patients with acutely decompensated chronic liver disease. It is characterised by high 28-day mortality, the presence of one or more organ failures (OFs) and a variable but severe grade of systemic inflammation. Despite the peculiarity of each one, every definition proposed for ACLF recognizes it as a proper clinical entity. In this paper, we provide an overview of the diagnostic criteria proposed by the different scientific societies and the clinical characteristics of the syndrome. Established and experimental treatments are also described. Among the former, the most relevant are directed to support organ failures, treat precipitating factors and carry out early assessment for liver transplantation (LT). Further studies are needed to better clarify pathophysiology of the syndrome and discover new therapies.

**Keywords:** acute-on-chronic liver failure (ACLF); cirrhosis; liver transplantation (LT)

**Citation:** Gambino, C.; Piano, S.; Angeli, P. Acute-on-Chronic Liver Failure in Cirrhosis. *J. Clin. Med.* **2021**, *10*, 4406. https://doi.org/10.3390/ jcm10194406

Academic Editors: Pierluigi Toniutto and Hiroki Nishikawa

Received: 31 August 2021 Accepted: 22 September 2021 Published: 26 September 2021

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