Acute exacerbated severe form of nonalcoholic steatohepatitis leading to acute-on-chronic liver failure: A case series

Metabolic associated fatty liver disease and acute-on-chronic liver failure: common themes for common problems

“…The chronic inflammatory milieu in patients with metabolic steatohepatitis cirrhosis could perpetuate the activation of the inflammasome and inflammatory nuclear pathways, predisposing them to the development of ACLF (Fig. 2) [19,20,[22][23][24]39].…”

“…2. Pathophysiology of metabolic associated fatty liver disease [19,20,[22][23][24]39]. Free fatty acids trigger Toll-like receptor 4 (TLR4) pathway that activates nuclear NFκB, stimulating the secretion of tumor necrosis factor-α (TNFα) and interleukin-6 (IL-6).…”

“…3. Pathogenesis of acute-on-chronic liver failure [15,[17][18][19][20]57]. Precipitating factors include alcohol intake, sepsis, viral infection, surgery, paracentesis without albumin infusion, autoimmune hepatitis and acute Wilson's disease.…”

“…Recently, it has been proposed that severe metabolic steatohepatitis could trigger ACLF; however, more information is needed (Fig. 3) [15,[17][18][19][20]57].…”

“…MAFLD cirrhosis is increasing as a cause of ACLF-related hospitalization in the US and around the world [18]. Interestingly, severe acute metabolic steatohepatitis was recently described as a possible precipitating event that could trigger ACLF [19]. It has been proposed that MAFLD-related obesity, altered gut permeability (‘leaky gut’), chronic inflammation and dysbiosis in MAFLD cirrhotic patients could predispose them to the development of ACLF; however, this relationship remains unproven [20].…”