Evidence map›Paper›PMID 42533257›Full record

ArticleHepatology international2026

A global consensus on the critical care management of acute-on-chronic liver failure patients: the APASL ACLF Beijing Position Paper.

Tao Chen, Ashok Choudhury, Wei Liu, Meng Zhang, Wenhui Wu, Huiling Xiang, Xiaojing Wang, Zaigham Abbas, Tatsuo Kanda, Ramazan Idilman and 100 more

Abstract readConsensus Statement
PubMed Publisher
In one paragraph

Article in Hepatology international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

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2 citing papers in PubMed.

  1. Article
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4 · The record

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5 · Who and what money

Authors and funding

110 authors.

Tao ChenDepartment of Infectious Diseases, Tongji Hospital, Tongji Medical College and State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Disease, Hubei Provincial Clinical Study Center of Viral Hepatitis, Huazhong University of Science and Technology, Wuhan Province, 430030, Hubei, China.
Ashok ChoudhuryDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Wei LiuDepartment of Infectious Diseases, Tongji Hospital, Tongji Medical College and State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Disease, Hubei Provincial Clinical Study Center of Viral Hepatitis, Huazhong University of Science and Technology, Wuhan Province, 430030, Hubei, China.
Meng ZhangDepartment of Infectious Diseases, Tongji Hospital, Tongji Medical College and State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Disease, Hubei Provincial Clinical Study Center of Viral Hepatitis, Huazhong University of Science and Technology, Wuhan Province, 430030, Hubei, China.
Wenhui WuDepartment of Infectious Diseases, Tongji Hospital, Tongji Medical College and State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Disease, Hubei Provincial Clinical Study Center of Viral Hepatitis, Huazhong University of Science and Technology, Wuhan Province, 430030, Hubei, China.
Huiling XiangDepartment of Infectious Diseases, Tongji Hospital, Tongji Medical College and State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Disease, Hubei Provincial Clinical Study Center of Viral Hepatitis, Huazhong University of Science and Technology, Wuhan Province, 430030, Hubei, China.
Xiaojing WangDepartment of Infectious Diseases, Tongji Hospital, Tongji Medical College and State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Disease, Hubei Provincial Clinical Study Center of Viral Hepatitis, Huazhong University of Science and Technology, Wuhan Province, 430030, Hubei, China.
Zaigham AbbasZiauddin University Hospital, Karachi, Pakistan.
Tatsuo KandaDivision of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma, 949-7302, Japan.
Ramazan IdilmanDepartment of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
Kemal Fariz KalistaDr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia.
Hai LiSchool of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China.
Rosmawati Binti MohamedDepartment of Medicine, Faculty of Medicine, National University Malaysia, Kuala Lumpur, Malaysia.
Paolo AngeliDepartment of Medicine (DIMED), University of Padova, Padua, Italy.
Mohamed ElbasionyHepatology and Gastroenterology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Hasitha S WijewanthaNational Hospital-Kandy, Kandy, Sri Lanka.
Charles PanackelAster Medcity, Ernakulam, Kerala, India.
Kessarin ThanapiromDivision of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Ashwani K SingalTrager Transplant Center and Jewish Hospital, University of Louisville School of Medicine, Louisville, KY, USA.
Khin Maung WinUniversity of Medicine, Yangon Ministry of Health, Yangon, Myanmar.
Debbie L ShawcrossRoger Williams-Institute of Liver Studies, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Elliot B TapperDivision of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
Ananta ShresthaAlka Hospital, Kathmandu, Nepal.
Jonel TrebickaMedizinische Klinik B, Universitätsklinikum Münster, Münster, Germany.
Abdul Kadir DokmeciAnkara University School of Medicine, Ankara, Turkey.
Aleksander KragUniversity of Southern Denmark, Odense, Denmark.
Anand V KulkarniDepartment of Hepatology and Liver Transplantation, Asian Institute of Gastroenterology (AIG) Hospitals, Hyderabad, India.
Jinhua HuThe Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China.
Haibin SuThe Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China.
Gupse AdaliUniversity of Health Sciences, Ümraniye, Istanbul, Turkey.
Rahul KumarChangi General Hospital, Singapore, Singapore.
George K LauHumanity and Health Medical Center, Hongkong, SAR, China.
Anil AroraSir Ganga Ram Hospital, Rajender Nagar, New Delhi, India.
Javier FernandezLiver ICU, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona and CIBERehd, Barcelona, Spain.
Tawesak TanwandeeSiriraj Hospital, Mahidol University, Bangkok, Thailand.
Dong Joon KimHallym University, Chuncheon, Republic of Korea.
Mamun-Al-MahtabBangladesh Medical University, Dhaka, Bangladesh.
Saeed HamidDepartment of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Cosmas Rinaldi A LesmanaDr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia.
Gokhan KabacamDepartment of Gastroenterology, Güven Hospital, Ankara, Turkey.
Nipun VermaDepartment of Hepatology, PGIMER, Chandigarh, India.
Amna Subhan ButtAga Khan University Hospital, Karachi, Pakistan.
Daniel Q HuangDivision of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore.
Sunil TanejaDepartment of Hepatology, PGIMER, Chandigarh, India.
Ashish GoelChristian Medical College (CMC), Vellore, India.
Sakkarin ChirapongsathornPhramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
Wasim JafriAga Khan University Hospital, Karachi, Pakistan.
Rakhi MaiwallDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
R K DhimanSanjay Gandhi Post Graduate Institute (SGPGI), Lucknow, Uttar Pradesh, India.
Jasmohan BajajVirginia Commonwealth University, Richmond, VA, USA.
Cesar YaghiSaint Joseph University, Hôtel-Dieu de France University Medical Center, Beirut, Lebanon.
Barjesh Chander SharmaGovind Ballabh Pant Hospital, New Delhi, India.
Arun ValsanAmrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India.
James FungQueen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Madhumita PremkumarDepartment of Hepatology, PGIMER, Chandigarh, India.
Constantine J KarvellasUniversity of Alberta, Edmonton, AB, Canada.
Lubna KamaniLiaquat National Hospital, Karachi, Sindh, Pakistan.
Sanjaya K SatapathyDepartment of Gastroenterology and Transplant Hepatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, 11040, USA.
Igor G BakulinA.S. Loginov Moscow Clinical Scientific Center of Moscow Healthcare Department, Moscow, Russia.
Sumeet AsraniBaylor Simmons Transplant Institute, Dallas, TX, USA.
Hasmik GhazinianYerevan Medical Scientific Center, Yerevan, Armenia.
Akash RoyApollo Multispeciality Hospital, Kolkata, India.
Imelda Maria LohoDivision of Gastroenterology and Hepatology, Dharmais National Cancer Hospital, Jakarta, Indonesia.
Diana Alcantara PayawalFatima University Medical Center, Valenzuela Metro Manila, Philippines.
ShalimarAll India Institute of Medical Sciences (AIIMS), New Delhi, India.
Manoj K SharmaDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Ruben HernaezSection of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Zhongping DuanLiver Disease Center (Difficult and Complicated Liver Diseases and Artificial Liver Center), Beijing You'an Hospital Affiliated to Capital Medical University, Beijing, China.
Ruveena Bhawani RajaramUniversity of Malaya, Kuala Lumpur, Malaysia.
Atsushi TanakaTeikyo University School of Medicine, Tokyo, Japan.
Suprabhat GiriKalinga Institute of Medical Sciences (KIMS), Bhubaneshwar, Orissa, India.
Madunil A NiriellaUniversity of Kelaniya, Ragama, Sri Lanka.
Sunil DadhichDr. Sampurnanand Medical College and Associated Group of Hospitals (S N Medical College), Jodhpur, Rajasthan, India.
Vinod AroraDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Jun LiThe First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Mohd Golam AzamEndocrine and Metabolic Disorder (BIRDEM) Shahbad, Bangladesh Institute of Research and Rehabilitation in Diabetes, Dhaka, Bangladesh.
Rajiv JalanLiver Failure Group, UCL Institute for Liver and Digestive Health, London, UK.
Ashish KumarSir Ganga Ram Hospital, Rajender Nagar, New Delhi, India.
Akash ShuklaSeth G S Medical College and K E M Hospital, Mumbai, Maharashtra, India.
Santhosh E KumarChristian Medical College (CMC), Vellore, India.
Vincent Wai-Sun WongFaculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
C E EapenChristian Medical College (CMC), Vellore, India.
Shahinul AlamBangladesh Medical University, Dhaka, Bangladesh.
Ming Lung YuHepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Yogesh K ChawlaKalinga Institute of Medical Sciences (KIMS), Bhubaneshwar, Orissa, India.
Gamal E ShihaHepatology and Gastroenterology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Ajay DusejaDepartment of Hepatology, PGIMER, Chandigarh, India.
Soek Siam TanSelayang Hospital, Baru Caves, Selangor, Malaysia.
Narendra Singh ChoudharyMedanta-The Medicity Hospital, Gurugram, Haryana, India.
Mohamed RelaDr. Rela Institute and Medical Centre, Chennai, India.
Albert C Y ChanQueen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Prashant BhanguiMedanta-The Medicity Hospital, Gurugram, Haryana, India.
Francois DurandHepatology and Liver Intensive Care, Hospital Beaujon, University Paris Cité, Clichy, Paris, France.
Ramon BatallerLiver Unit, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Mark Dhinesh MuthiahDivision of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore.
Nadim MahmudUniversity of Pennsylvania, Philadelphia, PA, USA.
Mamatha BhatAjmera Transplant Program, University Health Network, Toronto, ON, Canada.
Sanjiv SaigalMax Super Specialty Hospital Saket, New Delhi, India.
Juan Pablo ArabEscuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Yoon Jun KimSeoul National University College of Medicine, Seoul, Republic of Korea.
Manal Hamdy El-SayedAin Shams University, Cairo, Egypt.
Jinlin HouGuangdong Provincial Key Laboratory of Viral Hepatitis Research, Guangdong Provincial Clinical Research Center for Viral Hepatitis, Key Laboratory of Infectious Diseases Research in South China, Ministry of Education, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Jidong JiaLiver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Necati Ormeciİstanbul Health and Technology University, Istanbul, Turkey.
Lai WeiChanggung Hospital, Tsinghua University, Beijing, China.
Masao OmataYamanashi Central Hospital, Yamanashi, Japan.
Paul Y KwoDivision of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA, USA. pkwo@stanford.edu.
Shiv Kumar SarinDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. shivsarin@gmail.com.
Qin NingDepartment of Infectious Diseases, Tongji Hospital, Tongji Medical College and State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Disease, Hubei Provincial Clinical Study Center of Viral Hepatitis, Huazhong University of Science and Technology, Wuhan Province, 430030, Hubei, China. qning@vip.sina.com.ORCID 0000-0002-2027-9593
APASL-ACLF Research Consortium (AARC) for APASL-ACLF Working Party

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimsAcute-on-chronic liver failure (ACLF) is a severe syndrome in patients with chronic liver disease, marked by rapid multi-organ failure and high short-term mortality. Managing ACLF requires intensive care, but standardized global guidelines were previously lacking. The APASL ACLF Research Consortium (AARC) developed this position paper to establish a unified, evidence-based consensus for its critical care management.

methodsA global collaboration of 109 experts employed a systematic methodology to address key aspects of ACLF care. Sections were drafted by specialist teams, with recommendations developed using the GRADE system. Draft statements underwent iterative review and refinement, followed by an expert panel consensus process consisting of open show-of-hands voting during the APASL Annual Conference in March 2025 in Beijing and a subsequent anonymous online voting round.

resultsThe consensus delivers 104 position statements. Key recommendations include using prognostic scores (AARC, CLIF-C ACLF, GIC) for ICU transfer and treatment decisions, and aggressively managing precipitating factors or complications like infections. It details organ-specific support for liver, kidney, and brain failure, advocating for early, targeted antibiotics and careful fluid management. The role of bridging therapies (plasma exchange, artificial liver systems) and nutritional support is emphasized. For transplantation, the guidelines provide criteria for patient selection and timing, particularly for alcohol-related ACLF.

conclusionsThe APASL ACLF Beijing Position Paper provides a comprehensive, standardized framework for managing critically sick ACLF patients. Integrating multidisciplinary expertise and current evidence, these guidelines aim to optimize care, inform clinical decisions, and improve survival for this high-risk population. As a few recommendations are supported predominantly by data from different continents, they should therefore be interpreted in local contexts.

Indexed as

Acute-On-Chronic Liver FailureCritical CareBeijingHumansPrognosisAcute-on-chronic liver failureCritical carePosition paperTreatment

Identifiers

PMID42533257

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.