Use of Oral N-Acetylcysteine (NAC) in Non-Acetaminophen-Induced Acute Hepatic Failure

Saleem Sharieff; Asim Idrees; Wajid Rafai; Syed Uzair S Bukhari

doi:10.7759/cureus.35852

Use of Oral N-Acetylcysteine (NAC) in Non-Acetaminophen-Induced Acute Hepatic Failure

Cureus. 2023 Mar 7;15(3):e35852. doi: 10.7759/cureus.35852. eCollection 2023 Mar.

Authors

Saleem Sharieff^{1

2}, Asim Idrees¹, Wajid Rafai¹, Syed Uzair S Bukhari³

Affiliations

¹ Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK.
² Medicine/Critical Care Medicine, Grand River Hospital, Kitchener, CAN.
³ Pharmacology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK.

Abstract

Background: Acute liver failure (ALF) is a syndrome rather than a specific disease with several possible causes, and viral hepatitis is a major cause. The objective of the study was to assess the benefit of N-acetylcysteine (NAC) in non-acetaminophen-induced acute liver failure (NAI-ALF).

Methods: A total of six patients with a diagnosis of acute liver failure (ALF) were included in the study. All six patients received oral NAC for 72 hrs. The parameters evaluated were demographic, clinical, biochemical, outcome, and length of ICU and hospital stay. The primary outcome was a reduction in mortality with the use of NAC in NAI-ALF. The secondary outcomes were to evaluate the safety of NAC and assess factors predicting mortality.

Results: All patients improved and returned to normal or near-normal liver function with the use of NAC. No side effects were noted, and the use of NAC was associated with a shorter hospital stay.

Conclusion: In patients with non-acetaminophen-related acute liver failure, N-acetyl-L-cysteine (NAC) significantly improves overall survival and also decreases the length of hospital stay.

Keywords: acute liver failure; fulminant liver failure; hepatic encephalopathy; oral n-acetylcysteine; survival.