Management of acute-on-chronic liver failure: rotational thromboelastometry may reduce substitution of coagulation factors in liver cirrhosis

With great interest we have read the manuscript by Angeli et al ,1 demonstrating development of acute-on-chronic liver failure (ACLF) as an accurate predictor for mortality in hospitalised patients with decompensated liver cirrhosis. The authors show that assessment of the chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score improves prognostic accuracy and is superior to the acute kidney injury (AKI) classification, when taken at 48 h after hospitalisation. Patients with acutely decompensated cirrhosis are in a severe condition and the manuscript shows that mortality is extremely high in patients with ACLF grade 3 (three or more organ failures). In a previous study, Reiberger et al 2 showed that therapy with β-blockers for variceal bleedings can effectively reduce decompensation of liver cirrhosis. Though, not all patients respond to this treatment. We would like to add a small contribution, which may improve management of these difficult to treat patients at high risk. One major difficulty in clinical management of patients with cirrhosis is impaired coagulation …