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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 al2 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 …
Contributors SB designed the study, acquired, analysed and interpreted data, and drafted the manuscript. J-PS analysed and interpreted data, and revised the manuscript for important intellectual content. GG and FHS acquired and interpreted data, and revised the manuscript for important intellectual content. AC designed the study, interpreted data and revised the manuscript for important intellectual content. All authors have approved the final submitted version.
Competing interests SB, J-PS, GG, FHS and AC declare that they have no competing interests in the research.
Ethics approval Ethikkommission am Universitätsklinikum Essen.
Provenance and peer review Not commissioned; internally peer reviewed.