Acute on Chronic Liver Failure Flashcards
In hospitalized patients w/ ACLF, we suggest the use of short-acting dexmedetomidine for sedation as compared to other available agents to shorten time to extubation.
conditional, very low evidence
In patients w/ cirrhosis and stages 2 and 3 AKI, we suggest IV albumin and vasoconstrictors as compared to albumin alone, to improve creatinine.
conditional, low evidence
In hospitalized patients w/ cirrhosis and HRS-AKI without high grade of ACLF or major cardiopulmonary or vascular disease, we suggest terlipressin or norepinephrine to improve renal function.
conditional, moderate and low evidence
In patient w/ cirrhosis and infections other than SBP, we recommend against albumin to improve renal function or mortality.
strong, high evidence
In patients w/ cirrhosis as compared to non-cirrhotic populations, we suggest there is an increased risk of VTE.
conditional, low evidence
In patients w/ ACLF and altered coagulation parameters, we suggest against transfusion in the absence of bleeding or a planned procedure.
conditional, low evidence
In patients w/ cirrhosis who require invasive procedures, we recommend the use of TEG or ROTEM, compared w/ INR, to more accurately assess transfusion needs.
conditional, moderate evidence
In hospitalized patients w/ ACLF because of a bacterial infection who have not responded to antibiotic therapy, we suggest suspicion of a MDR organism or fungal infection to improve detection.
conditional, very low evidence
In patients w/ cirrhosis, we suggest avoiding PPI unless there is a clear indication because PPI increases the risk of infection.
conditional, very low evidence
In patients w/ severe alcohol-associated hepatitis (MDF >/= 32; MELD > 20) in the absence of contraindications, we recommend the use of prednisolone or prednisone (40 mg/d) orally to improve 28-d mortality.
strong, moderate evidence
In patients w/ severe alcohol-associated hepatitis (MDF >/= 32; MELD > 20), we suggest against the use of pentoxifylline to improve 28-d mortality.
conditional, very low evidence
In patients w/ cirrhosis who are hospitalized, we suggest against the routine use of parenteral nutrition, enteral nutrition, or oral supplements to improve mortality.
N/A
In hospitalized patients w/ cirrhosis, we recommend against daily infusion of albumin to maintain > 3 g/dL to improve mortality, prevention of renal dysfunction, or infection.
strong, moderate evidence
In patient w/ cirrhosis and ACLF, we suggest against the use of G-CSF to improve mortality.
conditional, very low evidence
In patients w/ cirrhosis and ACLF who continue to require mechanical ventilation because of ARDS or brain-related conditions despite optimal therapy, we suggest against listing for LT to improve mortality.
conditional, very low evidence
