Prognostic Impact of Sepsis in ICU Patients with Alcohol-Related Acute-on-Chronic Liver Failure

Background and Aims Acute-on-chronic liver failure (ACLF) represents a life-threatening syndrome in cirrhosis, marked by organ failures and high short-term mortality. Alcohol-related cirrhosis is the leading underlying cause of ACLF in Europe. Infections evolving into sepsis are recognized precipitants, but their prognostic impact in critically ill patients with alcohol-related cirrhosis remains insufficiently defined. This study aimed to identify precipitating events of ACLF and to compare clinical characteristics and outcomes between sepsis- and non-sepsis-related cases. Methods We retrospectively analyzed 188 ICU patients with alcohol-related cirrhosis admitted for ACLF at a tertiary university hospital. ACLF was defined and graded according to EASL-CLIF criteria; sepsis was diagnosed following Sepsis-3 definitions. Precipitating events, infection sites, microbiology, organ support, and in-hospital outcomes were systematically assessed. Results Sepsis was the predominant precipitant, observed in 118 patients (62.8%), while 70 patients (37.2%) developed ACLF due to non-septic triggers. Sepsis-associated ACLF was characterized by higher disease severity (ACLF grade 2–3: 80.5% vs. 57.1%, p=0.004), higher CLIF-C ACLF scores (median 55 vs. 50, p=0.04), prolonged ICU stay (median 11 vs. 4.5 days, p