• Hepatitis

We read with interest the comments raised by Gleeson et al.1 We thank the authors for their valuable remarks.

The aim of our prospective study was not to investigate the natural history of alcoholic steatohepatitis (ASH). Therefore, patients were not selected based on the presence or absence of ASH. The primary aim of the study was to elucidate whether acute-on-chronic liver failure (ACLF), as defined in the literature,2–4 really exists as a clinical identity and more specifically as a complication of cirrhosis. We could demonstrate that among those with symptomatic cirrhosis (70/250 patients with alcoholic cirrhosis), there is a subgroup of patients which is …