• adult patients (≥ 18 years) admitted to the University Hospital of Antwerp (UZA), Belgium.

‣ Written informed consent from patient or if not possible due to encephalopathy (\> grade 2): legal representative

⁃ acute-on-chronic liver failure (ACLF) grade ≥ 2:

• Acute decompensation event (identifiable trigger)

∙ Hepatic encephalopathy grade ≥ 2

∙ Acute kidney injury (AKI) according to Kidney Disease: Improving Global Outcome (KDIGO) criteria stage 3 (≥ 3-fold increase of serum creatinine OR increase of serum creatinine to ≥ 4 mg/dl OR urine output ≤ 0.3 ml/kg/h for ≥ 24 hours OR anuria for ≥ 12 hours)

∙ Serum bilirubin ≥ 10 mg/dl

∙ Hemodynamic instability with vasopressor support (norepinephrine \> 0.05 mcg/kg/min)