Hepatic Failure Classification and Management

Classification of Hepatic Failure

Hepatic failure is classified into three main types: Type A (acute liver failure), Type B (portosystemic bypass/shunting), and Type C (cirrhosis-related), according to the European Association for the Study of the Liver 1, 2, 3
The American Association for the Study of Liver Diseases recommends classification of hepatic encephalopathy into four grades based on the severity of manifestations, including Grade I (shortened attention span, altered sleep rhythm), Grade II (inappropriate behavior, somnolence), Grade III (confusion, gross disorientation), and Grade IV (coma, no response to painful stimuli) 2

The European Association for the Study of the Liver suggests that differential diagnosis of hepatic encephalopathy should include metabolic disorders (diabetic conditions, electrolyte disorders), substance-related disorders (alcohol, drugs), neurological disorders (neuroinfections, nonconvulsive epilepsy), and other disorders (psychiatric disorders, severe medical stress) 1, 2, 3

The American Association for the Study of Liver Diseases recommends early transfer to an intensive care unit in a center with liver transplant capability for patients with acute liver failure (Type A) 6
The European Association for the Study of the Liver suggests that patients with acute-on-chronic liver failure (ACLF) should be classified according to the ACLF grading system based on the number of organ failures, and that early identification and treatment of precipitating factors is crucial 4