NAC for non-acetaminophen-induced acute liver failure

7 Jan

The role of N-acetylcysteine (NAC), a glutathione precursor, in the treatment of acetaminophen-induced acute liver failure is well established.

But what about liver failure not related to acetaminophen use?

A 2009 prospective study with historical controls of 47 adult patients was done diagnosed with non-acetaminophen-induced acute liver failure. 

The two groups were comparable for the etiology of liver failure, prothrombin time (PT), alanine aminotransferase, creatinine, albumin, etc.

On multivariable regression analysis, independent predictors of mortality were:

  • patients not given NAC (odds ratio [OR] = 10.3, 95% confidence interval [CI] = 1.6–65.7)
  • age older than 40 years (OR = 10.3, 95% CI = 2.0–52.5)
  • PT more than 50 s (OR = 15.4, 95% CI = 3.8–62.2)
  • patients requiring mechanical ventilation (OR = 20.1, 95% CI = 3.1–130.2)
  • interval between jaundice and hepatic encephalopathy > 7 days (OR = 5.0, 95% CI = 1.3–19.1) 


Take home point: The use of NAC correlates with a reduction in non-acetaminophen induced acute liver failure mortality and its use was safe.


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