Mucke MM, et al. – Objectives of this study were to independently verify the prognostic value of the recently established EASL–CLIF–Consortium definition of acute–on–chronic liver failure (ACLF) and to recognize new predictors of short–term mortality. In patients with acute decompensation of liver cirrhosis, the physicians affirmed the EASL–CLIF–Consortium definition of ACLF as a strong predictor of mortality. However, in infection–triggered ACLF, they had observed a remarkably higher mortality compared to other precipitating events.

• The authors retrospectively categorized patients with liver cirrhosis and the ICD-10 diagnosis of (sub)acute liver failure according to the EASL-CLIF-Consortium definition.
• They performed logistic regression analysis to identify clinical and epidemiological predictors of 30- and 90-day mortality.

• The authors enrolled 257 patients from 2008-2015.
• For ACLF, 173 (67%) patients met the EASL criteria [grade 1: n=43 (25%), grade 2: n=52 (30%), grade 3: n=79 (45%)].
• In patients without ACLF, mortality within 30 days was 3.6%, and 18.6%, 37.3% and 62.0% in patients with ACLF grades 1, 2, and 3, respectively.
• Outcome of patients with bacterial infection-triggered ACLF was distinct from non-infection triggered ACLF (71.6% vs. 33.8% 30-day survival, P
• In this study, pneumonia was a particularly frequent infection and burdened with high mortality.
• Moreover, infections with multi-drug-resistant organisms were frequent and independently correlated with mortality (P=0.030, OR=4.41), as was glycopeptide antibiotic therapy as initial empirical antibiotic therapy (P=0.005).