Acute-on-chronic liver failure: A predictor of poor prognosis in patients with variceal bleeding or a risk factor for variceal bleeding?

[2] first reported that 17.8% of 2,138 patients with acute variceal bleeding had ACLF at admission, and that the presence of ACLF was independently related to rebleeding and mortality. [...]we assumed that 10–20% of cases involving acute variceal bleeding may experience ACLF at admission or during hospitalization, suggesting the need for careful evaluation of patients with variceal bleeding. In the study population of Shin et al. [...]we could not compare the mortality between the two groups. [2] did not reveal the temporal relationship between variceal bleeding and ACLF. [...]we could not compare the survival according to the order of the two pathologic conditions.