A 67-year-old woman with a history of MASLD-related cirrhosis presents to the emergency department with worsening confusion, abdominal distension, and fatigue. Her symptoms developed over the last five days. On examination, she is jaundiced and drowsy, and is diagnosed with hepatic encephalopathy grade III (West Haven Criteria). Laboratory findings are as follows: bilirubin 14 mg/dL (239 µmol/L), creatinine 2.5 mg/dL (221 µmol/L), INR 2.3, arterial lactate 5.2 mmol/L, sodium 126 mmol/L, polymorphonuclear leukocyte count in ascites: 700/mm³ (consistent with SBP). She was treated with intravenous antibiotics, lactulose, rifaximin and albumin infusion. Her CLIF-C ACLF score is 66, which corresponds to ACLF grade: 3 (liver, kidney, brain failure, coagulation impairment).