TY - JOUR
T1 - A global consensus on the critical care management of acute-on-chronic liver failure patients
T2 - the APASL ACLF Beijing Position Paper
AU - APASL ACLF Research Consortium (AARC) for APASL ACLF working Party.
AU - Chen, Tao
AU - Choudhury, Ashok
AU - Liu, Wei
AU - Zhang, Meng
AU - Wu, Wenhui
AU - Xiang, Huiling
AU - Wang, Xiaojing
AU - Abbas, Zaigham
AU - Kanda, Tatsuo
AU - Idilman, Ramazan
AU - Kalista, Kemal Fariz
AU - Li, Hai
AU - Mohamed, Rosmawati Binti
AU - Angeli, Paolo
AU - Elbasiony, Mohamed
AU - Wijewantha, Hasitha S.
AU - Panackel, Charles
AU - Thanapirom, Kessarin
AU - Singal, Ashwani K.
AU - Win, Khin Maung
AU - Shawcross, Debbie L.
AU - Tapper, Elliot B.
AU - Shrestha, Ananta
AU - Trebicka, Jonel
AU - Dokmeci, Abdul Kadir
AU - Krag, Aleksander
AU - Kulkarni, Anand V.
AU - Hu, Jinhua
AU - Su, Haibin
AU - Adali, Gupse
AU - Kumar, Rahul
AU - Lau, George K.
AU - Arora, Anil
AU - Fernandez, Javier
AU - Tanwandee, Tawesak
AU - Kim, Dong Joon
AU - Mamun-Al-Mahtab,
AU - Hamid, Saeed
AU - Lesmana, Cosmas Rinaldi A.
AU - Kabacam, Gokhan
AU - Verma, Nipun
AU - Butt, Amna Subhan
AU - Huang, Daniel Q.
AU - Taneja, Sunil
AU - Goel, Ashish
AU - Chirapongsathorn, Sakkarin
AU - Jafri, Wasim
AU - Maiwall, Rakhi
AU - Dhiman, R. K.
AU - Bajaj, Jasmohan
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Asian Pacific Association for the Study of the Liver 2026.
PY - 2026
Y1 - 2026
N2 - 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 standardized 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 complications like infections. It details organ-specific support for liver, kidney, and brain failure, advocating for early, targeted antibiotics 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.
AB - 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 standardized 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 complications like infections. It details organ-specific support for liver, kidney, and brain failure, advocating for early, targeted antibiotics 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.
KW - Acute-on-chronic liver failure
KW - Critical care
KW - Position paper
KW - Treatment
UR - https://www.scopus.com/pages/publications/105047468862
U2 - 10.1007/s12072-026-11116-1
DO - 10.1007/s12072-026-11116-1
M3 - Article
C2 - 42533257
AN - SCOPUS:105047468862
SN - 1936-0533
JO - Hepatology International
JF - Hepatology International
ER -