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Comments on ‘Early features of acute-on-chronic liver failure: a prospective cohort study’
  1. Dermot Gleeson1,
  2. Elaine McFarlane1,
  3. Asha Dubé2,
  4. David A Elphick3
  1. 1Liver Unit, Royal Hallamshire Hospital Sheffield, UK
  2. 2Department of Histopathology, Royal Hallamshire Hospital Sheffield, UK
  3. 3Department of Gastroenterology, Chesterfield Royal Hospital, UK
  1. Correspondence to Dermot Gleeson, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK; dermot.gleeson{at}sth.nhs.uk

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We read with interest the study by Katoonizadeh et al1 of acute-on-chronic (alcoholic) liver failure (ACLF) and the accompanying Editorial,2 which cites our report3 of liver histology in decompensated alcoholic liver disease (ALD). We found features of alcoholic hepatitis (intralobular neutrophils, Mallory bodies and ballooning) to be more frequent and more severe in patients biopsied within a month of first onset of decompensation, compared with those biopsied before decompensation or later, and argued for a causal relationship. We acknowledge the strengths of the prospective study of Katoonizadeh et al1 but would interpret their results differently.

Their definition of ACLF1 excludes patients with no prior liver disease and also those without cirrhosis on biopsy. It thus excludes many patients with first presentation …

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