Acute-on-chronic liver failure: Objective admission and support criteria in the intensive care unit

Abstract

Cirrhosis is a leading cause of morbidity and mortality throughout the world. Significant complications include variceal bleeding, hepatic encephalopathy, hepatorenal syndrome, and infection. When these complications are severe, admission to the intensive care unit (ICU) is often required for organ support and management. Intensive care therapy can also serve as a bridge to liver transplantation. Along with decompensation of cirrhosis, the concept of acute-on-chronic liver failure (ACLF) has emerged. This involves an acute precipitating event, such as the development of infection in a patient with cirrhosis, which leads to acute deterioration of hepatic function and extrahepatic organ failure. Extrahepatic complications often include renal, cardiovascular, and respiratory failures. Patients with significant extrahepatic and hepatic failures need ICU admission for organ support. Again, in patients who are deemed suitable liver transplant candidates, intensive care management may allow bridging to liver transplantation. However, patients with a Chronic Liver Failure Consortium ACLF score greater than 70 at 48 to 72 hours post-ICU admission do not seem to benefit from ongoing intensive support and a palliative approach may be more appropriate.

Holographic Entropy Relations

“…First we use the area functional to determine the bulk extremal surface E A homologous to A (and therefore anchored to the entangling surface ∂A = j ∂A j .) 24 Second, we evaluate this area functional to determine the entropy…”

“…23 When we refer to boundary surfaces as having a particular bulkcodimension we are viewing the boundary as part of the bulk spacetime (at least topologically). 24 Note that the number of regions A i , the number of entangling surfaces ∂A j , and the number of connected components of the corresponding extremal surface E A can all be distinct. Furthermore, these numbers are likewise completely unrelated to the number of partitions N and the number of spacetime boundaries M.…”

“…As will become clear in the course of our discussion, much of what we say will continue to apply in the planar limit even when higher curvature corrections are taken into account. In such situations we should use the general prescription given by [] for computing the semi‐classical field theory entanglement which involves a geometric functional built from intrinsic and extrinsic curvatures of a codimension‐2 bulk surface. However, the only crucial point for our analysis is the fact that there is a bulk surface which is associated with the field theory entanglement.…”

Distance conjecture and de-Sitter quantum gravity

“…Being rooted in the standard AdS/CFT correspondence, DS/dS inherits a prescription for how to calculate entanglement entropies in the d-dimensional field theory in terms of minimal surfaces in the D dimensional geometry [15] as was explored in [1,16]. For a DS D spacetime these calculations allowed two very different ways to understand the Gibbons Hawking (GH) entropy associated with the de Sitter horizon.…”

“…Here it doesn't matter whether we look at the D or d dimensional GH entropy; they are identical [12]. The calculations of [16] determined the entanglement between the two CFTs of the holographic dual on the entire spatial slice of the dS d spacetime they live on, finding perfect agreement with the DS D entropy. We'll refer to this entanglement between the two CFTs as the "left/right entanglement".…”