The natural history of pre-ACLF differs significantly from other acutely decompensated states with evidence of more severe systemic inflammation (higher C-reactive protein [CRP] and white blood cell count [WBC]), ascites, and presence of organ dysfunction (liver failure/dysfunction, kidney and coagulation dysfunctions) making them prone to develop ACLF.9, 10. The gene discussed is CRP; the disease is liver failure.