The patient is a 56-year-old male with known chronic viral hepatitis B (HBV) infection and a history of excessive alcohol consumption. He says he significantly reduced alcohol intake 3 months ago. Due to back pain, he used NSAID for the last 5 days up to admission. He is currently without medical treatment for HBV and now referred from his general practitioner to the emergency room with signs of acute decompensation with elevated liver enzymes (ALT 1445 U/L, bilirubin 234 micromol/L), ascites and hepatic encephalopathy grade 2. There are no signs of infection. The calculated MELD score is 22 and he has CLIF-C ACLF grade 3.