Are we ready to translate metabolomics into clinical practice for ACLF prediction and diagnosis?

Acute on chronic liver failure (ACLF) is currently defined by the presence of organ failures, with systemic inflammation and a high short-term mortality [1] Arroyo V. Moreau R. Jalan R. Acute-on-Chronic Liver Failure. N Engl J Med. 2020; 382: 2137-2145 Crossref PubMed Scopus (273) Google Scholar . Due to this high mortality and the potential diagnostic overlap between ACLF and other critical illnesses and decompensation, metabolomics could be an important tool to investigate patho-physiology, define treatment targets, and enhance prognostication [2] Jalan R. Saliba F. Pavesi M. Amoros A. Moreau R. Gines P. et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol. 2014; 61: 1038-1047 Abstract Full Text Full Text PDF PubMed Google Scholar ,[3] Wong F. Reddy K.R. Tandon P. Lai J.C. Jagarlamudi N. Weir V. et al. The Prediction of In-Hospital Mortality in Decompensated Cirrhosis with Acute-on-Chronic Liver Failure. Liver Transpl. 2022; 28: 560-570 Crossref Scopus (5) Google Scholar . These would then ideally be translatable into clinical practice to diagnose ACLF accurately and refine the prediction of ACLF, organ failures and mortality in hospitalized patients with chronic liver disease. Metabolic biomarkers significantly enhance the prediction of HBV-related ACLF occurrence and outcomesJournal of HepatologyPreviewAcute-on-chronic liver failure (ACLF) is a clinical syndrome associated with high short-term mortality in patients with chronic liver disease. Chronic hepatitis B is the main cause of ACLF (HBV-ACLF) in China and other Asian countries. To improve disease management and survival for patients with ACLF, we aimed to discover novel biomarkers to enhance HBV-ACLF diagnosis and prognostication. Full-Text PDF