Alcohol-related liver disease-associated acute-on-chronic liver failure: Mechanisms, dynamic assessment, and precise management

Na Ai; Huaining Cui; Xiaohui Fang; Tao Liu; Yanhang Gao

doi:10.12449/JCH260803

Volume 42 Issue 8

Aug. 2026

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Article Navigation > Journal of Clinical Hepatology > 2026 > 42(8): 1755-1760

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Alcohol-related liver disease-associated acute-on-chronic liver failure: Mechanisms, dynamic assessment, and precise management

DOI: 10.12449/JCH260803

Na Ai^{1, 2, 3},
Huaining Cui^{1, 2, 3},
Xiaohui Fang^{1, 2, 3},
Tao Liu^{1, 2, 3},
Yanhang Gao^{1, 2, 3
,
,
,}

1.
Department of Hepatology，Center of Infectious Diseases and Pathogen Biology，The First Hospital of Jilin University，Changchun 130021，China
2.
Jilin Provincial Key Laboratory of Metabolic Liver Diseases，Changchun 130021，China
3.
China-Singapore Belt and Road Joint Laboratory on Liver Disease Research，Changchun 130021，China

Research funding:

National Natural Science Foundation of China (U24A20654);

Natural Science Foundation for Self-Exploration Research of Jilin Province (YDZJ202401427ZYTS);

Jilin Provincial Key Laboratory of Metabolic Liver Diseases (YDZJ202502CXJD002);

Major Special Project of the National Key Laboratory of Jilin Province (BRI202602001GH);

National Key Research and Development Program of China (2024YFE0213800)

More Information

Corresponding author: Gao Yanhang， yanhang@jlu.edu.cn （ORCID： 0000-0001-8590-6706）
Received Date: 2026-05-06
Accepted Date: 2026-07-24
Published Date: 2026-08-25

Abstract

Abstract

Acute-on-chronic liver failure （ACLF） is a high-mortality syndrome that develops during the acute deterioration of chronic liver disease and is characterized by multiple organ dysfunction driven by systemic inflammation. Due to gut microbiota dysbiosis， endotoxin translocation， and amplified inflammatory responses， alcohol-related liver disease-associated ACLF （ALD-ACLF） is more pronounced and is often accompanied by a high risk of secondary infection and extrahepatic organ involvement， thereby exhibiting distinct etiological and clinical characteristics. This article systematically reviews the advances in the definitional boundaries， pathophysiological mechanisms， dynamic early warning， and prognostic assessment of ALD-ACLF， elaborates on risk stratification and key issues in clinical management， and discusses the potential impact of the dual-hit phenotype of metabolic dysfunction and alcohol-related liver disease on risk stratification in ALD-ACLF. This article also highlights the need to further strengthen etiology-oriented early identification， dynamic stratification， control of predisposing factors， and earlier intervention， in order to provide a reference for the precise assessment and individualized intervention of these patients.
- Acute-On-Chronic Liver Failure,
- Liver Diseases， Alcoholic,
- Disease Management

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References(30)

References

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Alcohol-related liver disease-associated acute-on-chronic liver failure: Mechanisms, dynamic assessment, and precise management

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