ABSTRACT
Decompensation of liver function is potentially life threatening: its presentation in the inten-
sive care unit is an urgent management problem. Acute liver failure occurs in two general
settings. First, and more commonly, a patient with preexisting chronic liver disease or cir-
rhosis develops an acute decompensation called acute-on-chronic liver failure (ACLF).
Most such patients have alcoholic or viral hepatitis cirrhosis; one of several comorbid
factors change the patient from the compensated to the decompensated state.
