Table 4.

Comparison of existing ACLF definitions [20–22, 26]

Item	APASL	CMA	EASL/CLIF	NACSELD
Circulation	NA	NA	Dopamine <5 or dobutamine or terlipressin	Shock: (MAP <60 or a reduction of 40 mmHg in systolic blood pressure from the baseline) despite adequate fluid resuscitation and cardiac output
Coagulation	INR ≥1.5 or PTA <40%	INR ≥1.5 or PTA <40%	INR ≥2.5 or platelet count <20 × 109/L	NA
Liver (TBil, mg/dL)	≥5	≥10 or increase 1 mg/dL/d	≥12	NA
Kidney (sCr, mg/dL)	NA	NA	≥2.0	Need for dialysis or other forms of renal replacement therapy
Cerebral (HE grade)	≥ I	NA	III or IV	III or IV
Respiratory	NA	NA	PaO2/FiO2: >100 to <200 or SpO2/FiO2: >89 to <214	Need for mechanical ventilator
Definition	TBil ≥5 mg/dL and INR ≥1.5 or PTA <40% complicated by ascites and/ or HE	INR ≥1.5 or PTA <40% and TBil ≥10 or increase 1 mg/dL/d	Grade 1:   (1) only sCr ≥2.0 mg/dL   (2) sCr: 1.5–1.9 mg/dL and/or HE I/II with one organ failure (liver, coagulation, circulation, or respiration)   (3) sCr: 1.5–1.9 mg/dL and HE III/IV   Grade 2: Two organ failures   Grade 3: Three organ failures or more	Two or more organ failures
Include chronic liver disease	Yes	Yes	No	No
Include compensated cirrhosis	Yes	Yes	Yes	Yes
Include decompensated cirrhosis	No	Yes	Yes	Yes
Include hepatic carcinoma	No	Yes	No	Disseminated malignancies are excluded

ACLF, acute-on-chronic liver failure; APASL, Asian Pacific Association for the Study of the Liver; CMA, Chinese Medical Association; EASL, European Association for the Study of the Liver; CLIF, Chronic Liver Failure Consortium; NACSELD, North American Consortium for the Study of End-Stage Liver Disease; NA, not applicable; MAP, mean arterial pressure; INR, international normalized ratio; PTA, prothrombin activity; TBil, total bilirubin; sCr, serum creatinine; HE, hepatic encephalopathy; PaO2; partial pressure of oxygen; FiO2, fraction of inspired oxygen; SpO2, blood oxygen saturation.