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The benefits of TIPS insertion for patients with ACLF outweigh the disadvantages, and TIPS should be considered as an option for variceal bleeding, potentially reducing the mortality rate of patients with ACLF and bleeding. [10] Gastrointestinal hemorrhage contributes mainly to the clinical course of UDC and despite the standard of care, timely control of bleeding, prevention of ACLF, and rebleeding and mortality are vital. Prevention and Treatment of Bleeding as Precipitant The management of bleeding as a precipitating event for AD or ACLF consists not only of bleeding control but also of prevention of ACLF (see above) and secondary prophylaxis. Keywords: TIPS; acute-on-chronic liver failure; variceal bleeding; systemic inflammation EN TIPS acute-on-chronic liver failure variceal bleeding systemic inflammation 189 205 17 07/18/23 20230501 NES 230501 Cirrhosis is the end stage of liver fibrosis following chronic and sustained injury to the liver leading to parenchymal extinction, regenerative nodules, and the arise of completely vascularized fibrotic septa responsible for portosystemic shunting. [Extracted from the article]