[Research advances in immune and metabolic dysregulation in the diagnosis and treatment of acute-on-chronic liver failure].

Acute-on-chronic liver failure (ACLF) has rapid onset and progression, with an extremely high short-term mortality rate. Accurate assessment and early intervention are crucial in clinical diagnosis and treatment. The core pathophysiological mechanisms of ACLF involve immune and metabolic dysregulation, which do not occur in isolation but instead interact through an "immune-metabolic interaction axis," mutually driving each other and evolving dynamically. Immune dysregulation is characterized by a dynamic transition from a systemic hyperinflammatory state to immunosuppression, whereas metabolic dysregulation is centered on mitochondrial dysfunction, triggering the reprogramming of multiple metabolic pathways. The interplay between these processes creates a vicious cycle that collectively drives disease progression. In recent years, with the deepening of mechanism research, various immune-and metabolic-related biomarkers have been identified and gradually applied in clinical evaluation and treatment. This article systematically reviews the current research status of immune and metabolic dysregulation in patients with ACLF and explores the potential application prospects of related biomarkers in diagnosis and treatment.