Acute-On-Chronic Liver Failure With Discordant Severity Assessments Following Binge Drinking: A Case Report.

Acute-on-chronic liver failure (ACLF) is associated with high short-term mortality. We report a man in his 50s with alcohol-related cirrhosis who developed ACLF following binge drinking. Despite being classified as grade 1 ACLF according to the Japanese severity classification, he presented with severe metabolic acidosis and marked hyperlactatemia and died 4 h after admission. Another prognostic scoring system classified him in the most severe category. This case illustrates that different severity assessments may provide complementary information regarding ACLF severity and prognosis and underscores the importance of repeatedly addressing problematic alcohol use and facilitating engagement in specialized addiction treatment during outpatient care.