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Bajaj 3 , Thierry Gustot 4 , Thomas Reiberger 5 , Mireia Torres 6 , Peter Nelson 6 , Javier Fernandez 7,8 and On behalf of the APACHE Study Investigators, (1)Rutgers-New Jersey Medical School, (2)Asst GOM Niguarda, (3)Virginia Commonwealth University, (4)HUB Erasme Hospital, Universit Libre De Bruxelles, (5)Medical University of Vienna, (6)Grifols, (7)EF Clif, Easl-Clif Consortium and Grifols Chair, (8)Hospital Clnic, Idibaps and Ciberehd Background: Acute-on-chronic liver failure (ACLF) is an increasingly recognized syndrome in patients with cirrhosis, characterized by acute decompensation of cirrhosis that results in severe organ injury with high rates of short-term mortality