Health · Medical Research · 8 hrs ago
Liver experts agree on a global definition of acute-on-chronic liver failure
Liver experts from around the world agreed on a shared definition of acute-on-chronic liver failure, or ACLF.
It affects people with existing liver disease whose condition suddenly worsens after an acute injury, such as alcohol-related harm or a viral infection.
ACLF was defined differently in different parts of the world, making it hard to distinguish from acute liver failure, which occurs without a prior liver illness.
The new definition requires a bilirubin level of at least 1.5 and an international normalized ratio, or INR, of at least 5; doctors then assess problems in other organs.
The confusion could delay treatment and make it harder to compare research or develop therapies.
Experts from five liver societies and other groups met in Barcelona in May to develop the definition, which also offers guidance on drug-induced liver injury, transplants and clinical trials.
Doctors and researchers can now use a common standard as they assess patients and work on treatments.
Liver experts from around the world have agreed on a unified definition of acute-on-chronic liver failure (ACLF).
The definition is intended to address differences in how the condition was diagnosed across regions.
It requires a bilirubin level of at least 1.5 and an international normalized ratio of at least 5.
The criteria also call for assessing dysfunction in the brain, kidneys, circulatory system or respiratory system.
A position paper published in Hepatology includes guidance on drug-induced liver injury, transplantation and clinical trial endpoints.
- Who
- Experts from five liver societies, along with pharmaceutical companies and regulators, took part in developing the definition.
- What
- They agreed on a unified definition of acute-on-chronic liver failure.
- When
- The experts met in May; their position paper was published the month before the article appeared on Nov. 9, 2026.
- Where
- The meeting took place in Barcelona.
- Why
- Definitions varied around the world, causing confusion and potentially delaying treatment, and making a common approach to therapies and clinical trials difficult.
This story does not have two clearly opposing sides.
Experts from five liver societies, pharmaceutical companies and regulators gathered in Barcelona to develop a unified definition.
The group’s position paper was published in Hepatology, according to the article published the following month.
- Bilirubin threshold
- At least 1.5
- INR threshold
- At least 5
- Meeting location
- Barcelona
- Participating liver societies
- Five
- Position paper journal
- Hepatology
What people are saying
It was just so confusing that, even though inherently some people believed in the concept, they didn’t know what to do with it
We can now move forward and focus on what the patient is there for: to get healed, get better