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We read with interest the recent paper by Angeli et al 1 investigating the acute-on-chronic liver failure classification in comparison to the acute kidney injury classification as a prognostic parameter in patients with decompensated cirrhosis. Higher stages of acute-on-chronic liver failure were accompanied with mortality and more frequently bacterial infections were identified in patients with multiorgan failure in this large cohort of patients. It is well known that patients with cirrhosis are at high risk for bacterial infections and bacterial infections are common causes of hepatic decompensations.2 Infectious complications significantly impair patients’ prognosis.2 ,3 However, especially hospital acquired infections are associated with high mortality.3 A common additional challenge is the worldwide …
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