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Two factors in particular, the presence of acute kidney injury and brain failure, have been established as independent predictors for mortality at 28 days and at 90 days, in patients with ACLF.103 Thus, mortality in patients with grade 1 ACLF varies from 23 to 41%, from 31 to 55% in patients with grade 2, and from 74 to 78% in patients with grade 3, at 28 days and 90 days, respectively.104 Additional specific care in patients with cirrhosis and hepatic encephalopathy 30 The use of certain drugs can precipitate HE in patients with cirrhosis