To Study and Compare the Clinical Course and Development of Organ Failure in Severe Acute Hepatitis Without Ascites, Non-cirrhotic and Cirrhotic Patients With Ascites [Acute on Chronic Liver Failure] and Acute Deterioration of Previously Decompensated Cirrhosis.

1. Cirrhosis: based on previous liver biopsy if available or based on clinical, imaging.

2. Severe acute hepatitis [14]: fulfilling any 2 of the 3 criteria:

   • Hepatic encephalopathy,
   • Serum bilirubin equal to or more than 10 mg/dl
   • International normalized ratio (INR) more than or equal to 1.6
3. Acute on chronic liver failure [3]: Acute hepatic insult manifesting as jaundice (serum bilirubin ≥ 5mg/dL) and coagulopathy (INR ≥ 1.5), complicated within 4 weeks by ascites and/or encephalopathy in patients with previously diagnosed or undiagnosed chronic liver disease/cirrhosis, and is associated with a high 28-day mortality.
4. Acute deterioration of decompensated cirrhosis [4]: Acute decompensation of cirrhosis in the form of one or more major complications of liver disease, including ascites, hepatic encephalopathy, gastrointestinal bleeding.

Inclusion Criteria:

• All consecutive patients presenting to hospital with bilirubin ≥5 and INR≥1.5
• Cirrhosis with or without Decompensation presenting with acute deterioration in less than 3 month

Exclusion Criteria:

• Cirrhosis with chronic decompensation.
• Patient on anticoagulant
• Hepatocellular carcinoma
• Septic shock
• Post-liver transplant or resection