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    A global consensus on the critical care management of acute‑on‑chronic liver failure patients: The APASL ACLF beijing position paper
    (Springer Nature Link, 2026) Chen, Tao; Choudhury, Ashok; Liu, Wei; Zhang, Meng; Wu, Wenhui; Xiang, Huiling; Wang, Xiaojing; Abbas, Zaigham; Örmeci, Necati; Ning, Qin
    Background and aims Acute-on-chronic liver failure (ACLF) is a severe syndrome in patients with chronic liver disease, marked by rapid multi-organ failure and high short-term mortality. Managing ACLF requires intensive care, but standard ized global guidelines were previously lacking. The APASL ACLF Research Consortium (AARC) developed this position paper to establish a unified, evidence-based consensus for its critical care management. Methods A global collaboration of 109 experts employed a systematic methodology to address key aspects of ACLF care. Sections were drafted by specialist teams, with recommendations developed using the GRADE system. Draft statements underwent iterative review and refinement, followed by an expert panel consensus process consisting of open show-of-hands voting during the APASL Annual Conference in March 2025 in Beijing and a subsequent anonymous online voting round. Results The consensus delivers 104 position statements. Key recommendations include using prognostic scores (AARC, CLIF-C ACLF, GIC) for ICU transfer and treatment decisions, and aggressively managing precipitating factors or complica tions like infections. It details organ-specific support for liver, kidney, and brain failure, advocating for early, targeted antibi otics and careful fluid management. The role of bridging therapies (plasma exchange, artificial liver systems) and nutritional support is emphasized. For transplantation, the guidelines provide criteria for patient selection and timing, particularly for alcohol-related ACLF. Conclusions The APASL ACLF Beijing Position Paper provides a comprehensive, standardized framework for managing critically sick ACLF patients. Integrating multidisciplinary expertise and current evidence, these guidelines aim to optimize care, inform clinical decisions, and improve survival for this high-risk population. As a few recommendations are supported predominantly by data from different continents, they should therefore be interpreted in local contexts.
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    Tolerance and acceptance of hepatic venous pressure gradient measurement in cirrhosis (CHESS1904): An international multicenter study
    (Wiley, 2022) Sun, Jun‐Hui; Zhao, He; Zhang, Haijun; Lei, Li; Örmeci, Necati; Yu, Zi‐Niu; Li, Xun; Li, Shuangxi; Yang, Xujun; Wei, Huaping; Zhu, Xiaoliang; Zhang, Zhengcong; Wang, Yajin; Zhao, Zhongwei; Mao, Jianting; Wu, Qiaohong; Sun, Xiaole; Xiang, Huiling; Jia, Kefeng; Yang, Chao; Wu, Wei; Lin, Xiuqing; Yao, Haixin; Zuo, Changzeng; Wang, Jitao; Zhang, Bo; Zhang, Chunqing; Wu, Xiaoling; Wang, Guangchuan; Yao, Shengjuan; Wang, Ruihang; Zhou, Li; Huan, Hui; Tu, Qingli; Pu, Xue; Zhang, Feng; Yin, Qin; Zhang, Linpeng; Guo, Ying; Wang, Jian; Kotani, Kohei; Uchida‐Kobayashi, Sawako; Kawada, Norifumi; Zhu, He; Li, Li; Wang, Wei; Zhang, Guo; Yu, Lei; Cui, Xudong; Zhu, Qingliang; Zhang, Hailong; Hui, Xiaoli; O. Ximenes, Rafael; de Araújo, Adriano Gonçalves; Gardenghi, Giulliano; Zheng, Yubao; Wu, Zebin; Huang, Mingsheng; Chen, Xiaoyong; Wu, Jun; Xie, Feng; Bo, Yang; Hu, Shengjuan; Ma, Linke; Li, Xiao; Qi, Xiaolong
    Aim To determine the tolerance and acceptance of hepatic venous pressure gradient (HVPG) measurements in patients with liver cirrhosis. Methods This prospective international multicenter study included 271 patients with cirrhosis who were scheduled to undergo HVPG measurement between October 2019 and June 2020. Data related to the tolerance and acceptance of HVPG measurements were collected using descriptive questionnaires. Results HVPG measurements were technically successful in all 271 patients, with 141 (52.0%) undergoing HVPG measurement alone. The complication rate was 0.4%. Postoperative pain was significantly lower than preoperative expected pain (p < 0.001) and intraoperative pain (p < 0.001), and intraoperative pain was also significantly lower than preoperative expected pain (p = 0.036). No, mild, moderate, severe, and intolerable discomfort scores were reported by 36.9%, 44.6%, 11.1%, 6.3%, and 0.4% of these patients, respectively, during HVPG measurement and by 54.6% 32.5%, 11.4%, 1.5%, and 0%, respectively, after HVPG measurement. Of these patients, 39.5% had little understanding and 10% had no understanding of the value of HVPG measurement, with 35.1% and 4.1% regarding HVPG measurements as being of little or no help, respectively. Most patients reported that they would definitely (15.5%), probably (46.9%), or possibly (29.9%) choose to undergo additional HVPG measurements again, and 62.7% regarded the cost of the procedure as acceptable. Conclusion HVPG measurement was safe and well-tolerated in patients with cirrhosis, but patient education and communication are warranted to improve the acceptance of this procedure.