High risk of complications and acute-on-chronic liver failure in cirrhosis patients with acute pancreatitis

•liver cirrhosis (LC) predisposes to adverse outcomes of acute pancreatitis (AP), with high rates of acute-on-chronic liver failure (ACLF) and significant mortality.•cirrhosis patients require significantly more radiological and endoscopic interventions over the course of AP, with higher complication rates compared to non-cirrhotic AP patients.•adverse outcomes of LC-AP are not adequately predicted by established AP scores, but by SOFA, ACLFs and particularly MELD scores.•clinical evidence of overt portal hypertension identifies LC patients at highest risk of AP-related complications, further decompensation and death.