N-acetylcysteine treatment in viral-induced acute liver failure

Abstract

Background: Acute liver failure (ALF) is characterized by acute derangement of liver function and carries high mortality. Viral hepatitis is still one of the main causes of ALF in the India as well in world. A prospective case control study was carried with the aim to determine the effect of N-acetylcysteine (NAC) on survival of viral-ALF patients. Methods: 37 patients with a diagnosis of viral-ALF were included in the study. 18 patients received NAC infusion for 72 hrs whereas 19 patients in control group received placebo. The variables evaluated were demographic, biochemical, outcome and length of hospital stay. Results: Out of 37 viral-ALF patients, acute HEV-induced ALF (48.6%) was most common followed by HBV (24.3%) and HAV (21.6%). The two groups were comparable for the various baseline characteristics (age, INR, bilirubin, ALT, creatinine, albumin, grade of encephalopathy, mean grade of coma etc.). Use of NAC was associated with a shorter length of hospital stay of survived patients (p=0.024). A total of 20 of 37 (54.1%) patients died with ALF complications; 7 (38.9%) patients belonged to NAC group and 13 (68.4%) patients to control group (p=0.079). HEV induced ALF showed significant improved in survival than Non HEV induced ALF with NAC administration (p=0.022). Conclusions: HEV was the most frequently cause of viral-ALF. Overall survival was not improved by NAC. HEV induced ALF showed significant improved in survival than Non HEV induced ALF with NAC administration. NAC reduced duration of hospital stay.

Acute liver failure secondary to ABVD use

“…Various studies have discussed the benefits of NAC in the treatment of acetaminophen induced acute liver failure. Despite significant limitations, a recent prospective randomised case control trial conducted in 2017 showed NAC along with conventional treatment benefitted the patient with non-acetaminophen induced acute liver failure 24. The patient in this report declined a liver biopsy, and therefore it was not possible to confirm the particular cause of acute liver failure.…”

Effect of N-acetylcysteine in Indeterminate Acute Liver Failure

“…The previous study by us showed that NAC improved the overall survival in non-acetaminophen induced ALF with a more favourable effect on drug-induced ALF. [21] Other studies also reported NAC improved transplant-free survival in early stage non-acetaminophen ALF(both in adults and childrens). [22,23] The non favourable effect of NAC in indeterminate ALF could be because indeterminate ALF had an advanced grade of encephalopathy (Gr III & IV) and subacute presentation which are related to poor prognosis.…”

“…Due to a lack of OLT facility, NAC has emerged as a beneficial treatment for non-paracetamol ALF. [21][22][23] Role of NAC in Viral-ALF has not been studied in controlled trials. So the prospective study was carried out to determine the role of NAC on mortality in indeterminate ALF and also to evaluate the safety and efficacy of NAC and its impact on the duration of hospital stay at a tertiary care centre in Kashmir (North India).…”

“…[18,19] Therefore better cost-effective alternatives are needed in locations where facility is not available. N-Acetylcysteine (NAC) has a wellestablished role in paracetamol-induced ALF [20] although it is now also recommended in selected cases of non-paracetamol ALF [21][22][23] because of its multiple mechanisms of action.…”

Successful Treatment of Crizotinib-Induced Fulminant Liver Failure: A Case Report and Review of Literature

“…NAC is a thiol-containing agent that prevents hepatic damage by scavenging free oxygen radicals and replenishing glutathione stores [19,20]. It has anti-inflammatory, antioxidant, inotropic, and vasodilating properties that may help limit the toxicities from crizotinib [21,22]. e literature is not very clear about the benefit of using NAC in non-acetaminophen-induced acute liver failure (NAI-ALF).…”