Acute liver failure is an uncommon condition, and most patients should be treated in a liver unit where management of complications and assessment for and management of liver transplantation can be undertaken by teams experienced in the management of liver disease. Apart from primary ALF, secondary or acquired acute liver failure (i.e. liver failure following extrahepatic – mainly cardiovascular - organ failure like in hypoxic liver injury or cholestasis) is observed in 10-20 percent of critically ill patients. However, optimum management involves early identification of these patients and consequently it is vital that all intensivists can recognise the condition, assess severity, liaise with a liver unit if necessary and provide appropriate supportive and specific medical treatment through the period of assessment and transfer.

Chronic liver disease is relatively common, particularly in the context of alcohol and viral infection. Decompensation and new onset of acute on chronic liver failure is often due to sepsis or bleeding, and admission to ICU should be sought. Again, centres offering expertise in the management of these episodes can add to patient management and advice should be sought at an early stage.