COOLEY- Study: aCute On chrOnic Liver failurE Using the cYtosorb Device

Inclusion Criteria: * 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) Exclusion Criteria: * • known patient will against participation in the study or against the measures applied in the study * a decision made prior to inclusion to stop further treatment of the patient within the next 24 hours * no complete remission of malignancy including hepatocellular carcinoma within the past 12 months * ongoing intermittent or CRRT before study inclusion