A global consensus on the critical care management of acute‑on‑chronic liver failure patients: The APASL ACLF beijing position paper

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dc.authorid0009-0002-6386-4060
dc.authorid0000-0001-6540-2623
dc.authorid0000-0003-3986-6533
dc.authorid0000-0002-9513-5324
dc.authorid0000-0002-8909-2102
dc.authorid0000-0002-2027-9593
dc.contributor.authorChen, Tao
dc.contributor.authorChoudhury, Ashok
dc.contributor.authorLiu, Wei
dc.contributor.authorZhang, Meng
dc.contributor.authorWu, Wenhui
dc.contributor.authorXiang, Huiling
dc.contributor.authorWang, Xiaojing
dc.contributor.authorAbbas, Zaigham
dc.contributor.authorÖrmeci, Necati
dc.contributor.authorNing, Qin
dc.date.accessioned2026-08-03T11:38:31Z
dc.date.available2026-08-03T11:38:31Z
dc.date.issued2026
dc.departmentFakülteler, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, İç Hastalıkları Ana Bilim Dalı
dc.description.abstractBackground 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.
dc.identifier.citationChen, T., Choudhury, A., Liu, W., Zhang, M., Wu, W., Xiang, H., Wang, X., Abbas, Z., Örmeci, N., & Ning, Q. (2026). A global consensus on the critical care management of acute‑on‑chronic liver failure patients: The APASL ACLF beijing position paper. Hepatology International, 20(4), pp. 963-991. https://doi.org/10.1007/s12072-026-11116-1
dc.identifier.doi10.1007/s12072-026-11116-1
dc.identifier.endpage991
dc.identifier.issn1936-0541
dc.identifier.issn1936-0533
dc.identifier.issue4
dc.identifier.pmidPMID: 42533257
dc.identifier.scopus2-s2.0-105047468862
dc.identifier.scopusqualityQ1
dc.identifier.startpage963
dc.identifier.urihttps://doi.org/10.1007/s12072-026-11116-1
dc.identifier.urihttps://hdl.handle.net/20.500.13055/1576
dc.identifier.volume20
dc.identifier.wosWOS:001836628900001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.indekslendigikaynak.otherSCI-E - Science Citation Index Expanded
dc.institutionauthorÖrmeci, Necati
dc.institutionauthorid0000-0002-8909-2102
dc.language.isoen
dc.publisherSpringer Nature Link
dc.relation.ispartofHepatology International
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.subjectAcute-On-Chronic Liver Failure
dc.subjectCritical Care
dc.subjectTreatment
dc.subjectPosition Paper
dc.titleA global consensus on the critical care management of acute‑on‑chronic liver failure patients: The APASL ACLF beijing position paper
dc.typeEditorial
dspace.entity.typePublication

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