Acute-on-chronic liver failure (ACLF) is a serious form of acute decompensation of liver cirrhosis, which is characterized by multiple organ failure, systemic inflammatory response, and a high short-term mortality rate. In 2023, the European Association for the Study of the Liver gave recommendations to clinicians, aiming to help them with the diagnosis of ACLF, the decision of triage (whether it is necessary to transfer a patient to the ICU for treatment), the identification and management of acute predisposing factors, the identification of organs that need support or replacement therapy, the definition of potential criteria for ineffective ICU treatment, and the determination of potential indications for liver transplantation. This article gives an excerpt of the above main contents in the guidelines.