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Management of acute-on-chronic liver failure: rotational thromboelastometry may reduce substitution of coagulation factors in liver cirrhosis
  1. Sotiria Bedreli1,
  2. Jan-Peter Sowa1,
  3. Guido Gerken1,
  4. Fuat Hakan Saner2,
  5. Ali Canbay1
  1. 1 Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany
  2. 2 Department of General, Visceral and Transplantation Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
  1. Correspondence to Professor Ali Canbay, Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Hufelandstr. 55, Essen 45122, Germany; ali.canbay{at}

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With great interest we have read the manuscript by Angeli et al,1 demonstrating development of acute-on-chronic liver failure (ACLF) as an accurate predictor for mortality in hospitalised patients with decompensated liver cirrhosis. The authors show that assessment of the chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score improves prognostic accuracy and is superior to the acute kidney injury (AKI) classification, when taken at 48 h after hospitalisation. Patients with acutely decompensated cirrhosis are in a severe condition and the manuscript shows that mortality is extremely high in patients with ACLF grade 3 (three or more organ failures). In a previous study, Reiberger et al 2 showed that therapy with β-blockers for variceal bleedings can effectively reduce decompensation of liver cirrhosis. Though, not all patients respond to this treatment. We would like to add a small contribution, which may improve management of these difficult to treat patients at high risk.

One major difficulty in clinical management of patients with cirrhosis is impaired coagulation …

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