Table 2.

Comparison of the existing ACLF definitions commonly accepted

	APASL	EASL/CLIF	NASCELD
Definition	Acute hepatic insult manifesting as jaundice and coagulopathy Complicated within 4 weeks by ascites and/or encephalopathy in a patient with previously diagnosed or undiagnosed chronic liver disease associated with high mortality.	An acute deterioration of pre-existing chronic liver disease usually related to a precipitating event and associated with increased mortality at 3 months due to multisystem organ failure	A syndrome characterized by acute deterioration in a patient of cirrhosis due to infection presenting with two or more extrahepatic organ failure.
Study cohort	First consensus was the expert opinion, subsequently prospectively evaluated in 1402 patient, subsequently in 3300 patients.	Prospectively studied in 1343 patients	Prospectively studied in 507 patients
Inclusion	Compensated Cirrhosis (diagnosed or non-diagnosed) CLD but not cirrhosis Acute insult directed to liver Presentation with liver failure to start with Index presentation	Cirrhosis only Compensated or decompensated Renal failure is mandatory (not liver failure for defining ACLF) Presentation not necessarily be liver failure Can be repeated episodes ACLF	Cirrhosis only Compensated or decompensated Two extrahepatic organ failure Presentation not necessarily be liver failure Can be repeated episodes of ACLF
Diagnosis	Early, reversibility is likely and thus may affect outcome	Too late, reversibility is unlikely and thus may not affect outcome	Too late, reversibility is unlikely and thus may not affect outcome
Exclusion Criteria	Prior decompensation HCC	HCC	Patients who had infections but did not require hospital admission. Cirrhosis without infection. Immune-compromised patients with human immunodeficiency virus (HIV) infection, prior organ transplant, and disseminated malignancies
Homogeneity	Yes. Index presentation, previously unknown or compensated, acute hepatic insult leading to liver failure as the driver.	No. Any presentation, with prior decompensation or recent worsening of ongoing decompensation, acute insult is not directed to liver, in particular (40% are of unknown acute insult), not liver but extrahepatic organ failure, i.e., renal failure is must, systemic inflammation but not the liver as driver.	No. Any presentation, with prior decompensation or recent worsening of ongoing decompensation, acute insult is not directed to liver in particular Any extrahepatic organic failure
Time frame	4 weeks	4–12 weeks (variable)	Not defined
Acute insult	Hepatic	Hepatic or Systemic (extrahepatic)	Infection, i.e., systemic (extrahepatic)
Sepsis	Consequence/complication	Cause/precipitant	Cause/precipitant
Organ failure	Liver is primary to start with Others subsequently	Systemic inflammation leading to kidney failure as the primary with or without other organ failure	Systemic inflammation leading to extrahepatic organic failure
Disease severity score	AARC Score-prospective as well as validated	CLIF-C SOFA, Prospective but only expert opinion	MELD CLIF-C SOFA
Golden window	Well defined for therapy, i.e., by 7 days SIRS or sepsis as well as for decision regarding Liver Transplant	No such	No such
Pediatric cohort	Yes	None	None
Therapy	Regenerative and bridging therapy with good result	No such	No such
Reversibility of ACLF syndrome	Yes	Not described	Not described