Acute-on-chronic liver failure (ACLF) is an extremely relevant clinical entity, recently characterized by the Canonic Study (2013),1,2 consisting of the simultaneous development of acute decompensation (ascites, encephalopathy, and/or gastrointestinal hemorrhage) and single organ failure or multiorgan failure (involving the 6 major organ/systems—ie, liver, kidney, brain, coagulation, circulation, and respiration). Of note, among patients admitted for acute decompensation, the prevalence of ACLF is high, ranging from 25% to 40%.