Acute-on-chronic liver failure (ACLF) is the rapid deterioration of liver function in chronic liver disease often associated with the development of serious complications such as hepatorenal syndrome and hepatic encephalopathy (HE) within a short period of time. 1,2 The condition has a high rate of short-term mortality, with previous studies reporting that around 50%-90% ACLF patients will die within 1 month of diagnosis. 3,4 While the definition and etiology of ACLF differ between Eastern and Western countries, the condition is generally described as acute deterioration of pre-existing chronic liver disease, and guidelines identify patients with cirrhosis at a high risk of short-term mortality in cases that develop ACLF. Alcoholic liver disease is the most common etiology of ACLF in patients from Europe and North America; however, hepatitis B virus (HBV) infection represents the major etiology among patients from the Asia-Pacific region. Based on the results of the European Association for the Study of the Liver definition of ACLF, the Chinese Group on the Study of Severe Hepatitis B (COSSH) recently developed new criteria for HBV-ACLF and established a prognostic score based on characteristics of Chinese patients with HBV and chronic liver disease. 5 Regardless of the presence of cirrhosis, patients with chronic hepatitis B with total bilirubin (TBIL) of ≥205 μmol/L and international normalized ratio (INR) of ≥1.5 are defined as HBV-ACLF according to the new criteria for HBV-ACLF. These criteria bridge the
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