Acute-on-Chronic Liver Failure(beta)
In hospitalized decompensated cirrhotic patients, we recommend assessment for infection because infection is associated with the development of ACLF and increased mortality.
In hospitalized patients with ACLF, we suggest the use of short-acting dexmedetomidine for sedation as compared to other available agents to shorten time to extubation.
In patients with ACLF and altered coagulation parameters, we suggest against transfusion in the absence of bleeding or a planned procedure.
In patients with cirrhosis and SBP, we recommend albumin in addition to antibiotics to prevent AKI and subsequent organ failures.
In patients with cirrhosis and infections other than SBP, we recommend against albumin to improve renal function or mortality.
In patients with cirrhosis and elevated baseline sCr who are admitted to the hospital, we suggest monitoring renal function closely because elevated baseline creatinine is associated with worse renal outcomes and 30-day survival (but no data that closer monitoring improves these outcomes).
In hospitalized patients with cirrhosis, we recommend against daily infusion of albumin to maintain albumin >3 g/dL to improve mortality, prevention of renal dysfunction, or infection.
In patients with cirrhosis and ACLF, we suggest against the use of G-CSF to improve mortality.
In patients with end-stage liver disease admitted to the hospital, we suggest early goals of care discussion and if appropriate, referral to palliative care to improve resource utilization.
In patients with severe alcohol-associated hepatitis (MDF ≥ 32; MELD score > 20) in the absence of contraindications, we recommend the use of prednisolone or prednisone (40 mg/d) orally to improve 28-day mortality.
In patients with cirrhosis with a history of SBP, we suggest use of antibiotics for secondary SBP prophylaxis to prevent recurrent SBP (unable to comment on specific antibiotic choice).
In patients with cirrhosis in need of primary SBP prophylaxis, we suggest daily prophylactic antibiotics, although no one specific regimen is superior to another, to prevent SBP.
In patients with cirrhosis and suspected infection, we suggest early treatment with antibiotics to improve survival.
In hospitalized patients with ACLF because of a bacterial infection who have not responded to antibiotic therapy, we suggest suspicion of a MDR organism or fungal infection to improve detection.
In hospitalized patients with cirrhosis and HRS-AKI without high grade of ACLF or major cardiopulmonary or vascular disease, we suggest terlipressin to improve renal function.
In patients with cirrhosis and stages 2 and 3 AKI, we suggest IV albumin and vasoconstrictors as compared to albumin alone, to improve creatinine.
How strong is the ACG's recommendation?