N-acetylcysteine in acute hepatic failure (non-paracetamol-induced).
OBJECTIVE
Acute liver failure is a serious condition associated with poor prognosis. It may be associated with changes in systemic hemodynamics, i.e., tissue hypoxia, which contributes to multiple-organ failure. Recent studies have shown that N-acetylcysteine administered to patients with fulminant hepatic failure (paracetamol-induced) increases oxygen delivery and improves survival. The aim of this pilot study was to evaluate N-acetylcysteine administration to patients with non-paracetamol-induced acute liver failure and assess its effect on the clinical course and outcome.


METHODS
N-acetylcysteine was administered at presentation to 7 patients with non-paracetamol-induced acute liver failure. Patients were followed for changes in clinical parameters (grade of encephalopathy), coagulation factors, biochemical parameters and outcome.


RESULTS
Clinically, 3 patients who initially had grade O/II encephalopathy, did not progress, and have fully recovered. The mean peak prothrombin time, serum factor V, aspartate aminotransferase and alanine aminotransferase levels, all significantly improved. Four patients (57%) have recovered fully (1 patient, although fully recovered, died later from an unrelated cause). Two patients required orthotopic liver transplantation and 1 patient died. N-acetylcysteine administration may have prevented progression to grade III/IV encephalopathy and improved serum coagulation factors. This may account for its beneficial effect on survival in patients who had poor prognostic criteria at base-line. No side effects of the drug were noted.


CONCLUSIONS
This study suggests that N-acetylcysteine administration should be considered in all patients with acute liver failure.
Ben-Ari
Z
Z
Department of Medicine D, Rabin Medical Center, Petah Tiqva, Israel.
Vaknin
H
H
Tur-Kaspa
R
R
D000111:Acetylcysteine / Q000627:therapeutic use*; D000293:Adolescent; D018450:Disease Progression; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006501:Hepatic Encephalopathy / Q000517:prevention & control; D006801:Humans; D017114:Liver Failure, Acute / Q000188:drug therapy* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects
D016166:Free Radical Scavengers; D000111:Acetylcysteine