From cirrhosis to crisis: A case report of hepatic, renal, and pulmonary failure in acute on chronic liver disease

Chronic liver disease (CLD) is a progressive condition marked by the gradual loss of liver function, ultimately leading to cirrhosis, an end-stage manifestation characterized by architectural distortion of the liver, widespread nodule formation, vascular remodelling, neoangiogenesis, and extracellular matrix deposition. Among its various aetiologies, chronic alcohol consumption remains the leading cause. As the disease progresses, patients become highly susceptible to complications such as acute kidney injury (AKI), pulmonary complications, and pleural effusions, all of which increase morbidity and complicate management. A 35-year-old male with alcohol-associated CLD presented with unstable vital signs, ascites, jaundice, pedal edema, and dyspnoea. His clinical condition was further complicated by AKI, thrombocytopenia, and bilateral pleural effusion. He required multidisciplinary management in a Liver Intensive Care Unit (LICU), where he was treated with continuous renal replacement therapy (CRRT), along with antibiotics, antifungals, bronchodilators, thrombopoietin agonist therapy, and intensive nursing care guided by Roy’s adaptation model. Following four days of CRRT and targeted medical therapy, the patient showed clinical stabilization and was discharged on day 10 with advice on strict alcohol abstinence and psychiatric counseling. This case illustrates the complexity of acute on chronic liver failure (ACLF) and underscores the importance of integrating structured nursing frameworks such as Roy’s adaptation model into intensive care settings to enhance both physiological stabilization and psychosocial adaptation, alongside standard multidisciplinary management.