Table 1.

Comparison of features of human acute and acute-on-chronic liver failure syndromes.

	ALF	ACLF
Background liver	Normal	Chronic liver disease ± cirrhosis
Demographics*	Mean age: 36 Female preponderance	Mean age: 56 Male preponderance
Causes	Paracetamol/Acetaminophen Other drug-induced liver injury (DILI) Acute viral hepatitis Ischaemia Pregnancy related Autoimmune hepatitis	CLD: Any: Alcohol, chronic viral hepatitis, NASH, other Precipitant: Bacterial infection, alcohol consumption, GI bleed, viral reactivation, de novo viral hepatitis, ischaemia, DILI
Clinical features	Coagulopathy, jaundice, hepatic encephalopathy High incidence of SIRS, extrahepatic organ failure and susceptibility to infection	Coagulopathy, jaundice, and extrahepatic organ failure. High incidence of hepatic encephalopathy, SIRS, and susceptibility to infection
Infection susceptibility	Bacterial infection 35–40% Fungal infection 11.2%	37% bacterial infection at diagnosis, increasing to 66% by 4 weeks 2–3.5% fungal infections
Infection onset	Late (>5 days)	Early (< 5 days) and late
Mortality	40% hospital mortality	40–80% hospital mortality
DAMPs/Alarmins	IL-1α, IL-33, ATP, formyl peptides, mitochondrial DNA, cyclophilin A, histones, HMGB1	IL-33, histones, HMGB1

^*Patient demographics from large European cohorts, reflecting disease trends in this region. ACLF, acute-on-chronic liver failure; ALF, acute liver failure; ATP, adenosine triphosphate; CLD, chronic liver disease; DAMPs, damage-associated molecular patterns, DILI, drug-induced liver injury; GI, gastrointestinal bleeding; HMGB-1, high-mobility group box-1; IL, interleukin; NASH, non-alcoholic steatohepatitis; SIRS, systemic inflammatory response syndrome