ICU Map

Decompensated Cirrhosis & ACLF ICU Pathway

Recognition and organ-support of decompensated cirrhosis and acute-on-chronic liver failure, including bleeding, infection, encephalopathy and transplant triage

RecognizeAssessDecideDifferentialInterveneReassess
Decompensated Cirrhosis & ACLF
Assessment StepStabilize physiology and identify the reversible driverExplore Topic
Decompensation includes ascites, variceal hemorrhage, hepatic encephalopathy and infection. ACLF adds acute deterioration with extrahepatic organ failure and high short-term mortality; actively search for precipitating infection, bleeding, alcohol-associated hepatitis, drug injury, thrombosis and ischemia.
Clinical ActionDeliver disease-specific therapy and source control
Resuscitate with a restrictive transfusion strategy in most patients, start vasoactive therapy such as octreotide or terlipressin where appropriate, give short-course antibiotic prophylaxis, and arrange urgent endoscopy. Consider early/pre-emptive TIPS in selected high-risk patients after specialist assessment.

An educational representation of clinical reasoning, not a diagnostic algorithm or personalized medical advice — always apply clinical judgment and institutional protocols.

Caution

Escalate — Red Flags & Critical Warnings

  • Do not allow diagnostic testing to delay immediate stabilization or time-critical definitive therapy.

Related Bedside Clinical Problems (2)

Bedside Presentations
Decompensated Cirrhosis & ACLF — Bedside Problem

Recognition and organ-support of decompensated cirrhosis and acute-on-chronic liver failure, including bleeding, infection, encephalopathy and transplant triage

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Life-Threatening Upper GI Bleeding

Airway-aware resuscitation, variceal vs nonvariceal phenotype, urgent endoscopic hemostasis, and escalation to IR/TIPS/surgery when bleeding remains uncontrolled.

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Linked Deep-Dive Topics (1)

Reference Knowledge
Decompensated Cirrhosis & ACLFgi-hepatic

Recognition and organ-support of decompensated cirrhosis and acute-on-chronic liver failure, including bleeding, infection, encephalopathy and transplant triage

Explore Topic →

Evidence status

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