Acute-on-chronic liver failure（ACLF）is a syndrome of acute jaundice deepening and coagulopathy on the basis of chronic liver disease，which can be complicated by one or more extrahepatic organ failure.It is difficult to treat and the fatality rate is more than 50%.The complex pathogenesis of ACLF has not yet been clarified，which is one of the important reasons why the clinical ef⁃ ficacy of ACLF has not achieved a fundamental breakthrough for a long time.This paper reviewed the etiology，pathogenesis and treat⁃ ment of ACLF based on the latest evidence-based medical evidence，in order to help understand the pathogenesis of ACLF and provide reference for clinical workers to choose treatment plans.