Introduction     Acute on Chronic Liver Failure (ACLF) is associated with high mortality and requires early recognition and aggressive management.

Aim                  To evaluate the clinical profile of ACLF and study factors associated with a poor outcome

Materials and Methods             61 cases of ACLF were e valuated. Etiological work up and Trans–jugular liver biopsy was done in all patients.  Patients were followed up for a period of four weeks or till death (if earlier).

Results             The mean age of patients was 40.06 +/– 4.2 years.  Encephalopathy and GI Bleed was noted in 91.8% and 27.9% patients. Alcohol was the commonest etiology of chronic disease. Acute events were alcoholic hepatitis and viral hepatitis. Non–survivors had a higher incidence of GI Bleed and encephalopathy.

Conclusion      ACLF is associated with alcohol and viral hepatitis. GI bleed, Hepatic encephalopathy and type I histology are associated with a poor prognosis.