Akutechronisch

Akutechronisch is a medical term used to describe a situation in which an acute episode occurs on top of a pre-existing chronic condition. The term fuses the German words akut and chronisch and is used in medical literature to denote a pattern rather than a single disease. In practice it is often equivalent to the English phrase acute on chronic.

The concept is most commonly applied in nephrology, hepatology, and cardiology. Examples include acute kidney injury on chronic kidney disease, acute-on-chronic liver failure on cirrhosis, and acute decompensation in chronic heart failure. These scenarios reflect a rapid deterioration in function that compounds the baseline impairment caused by the chronic disease.

Clinical features and diagnosis rely on demonstrating both a chronic baseline and a new acute deterioration. This typically involves patient history, serial laboratory measurements, and sometimes imaging to assess organ function. Identified precipitating factors—such as infection, dehydration, medication changes, or nonadherence—are central to understanding and managing the episode.

Management targets the acute event while supporting the underlying chronic condition and addressing triggers. This often requires hospital care, organ-supportive measures, optimization of chronic therapies, and a multidisciplinary approach to treatment and follow-up.

Prognosis varies with the underlying chronic disease and the severity of the acute deterioration; acute-on-chronic states generally carry higher morbidity and mortality than either condition alone and may accelerate progression of the chronic disease. There is ongoing discussion about formal definitions and standardized criteria, with some authors preferring the term acute on chronic or akut-auf-chronisch in German usage.

See also: acute kidney injury on CKD; acute-on-chronic liver failure; acute decompensated heart failure.