title: Use of N-acetylcysteine in children with fulminant hepatic failure caused by acute viral hepatitis.
abstract: OBJECTIVE
  To determine the efficacy of N-acetylcysteine (NAC) in children aged > 1 month to 16 years admitted with Fulminant Hepatic Failure (FHF) secondary to Acute Viral Hepatitis (AVH) in a tertiary care center of a developing country.
  
  
  METHODS
  Analytical study.
  
  
  METHODS
  Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan, from January 2007 to December 2011.
  
  
  METHODS
  Medical records of children (> 1 month - 16 years) with FHF admitted with AVH of known etiology who received NAC were reviewed retrospectively. Liver function tests (mean ± SD) at baseline, 24 hours after NAC and before or at the time of discharge/death were recorded and compared via using repeated measures ANOVA(r-ANOVA). Efficacy of NAC is defined in improvement in biochemical markers, liver function test and discharge disposition (survived or died). Mortality associated risk factors were identified by using logistic regression analysis. P-value and 95% confidence interval were recorded.
  
  
  RESULTS
  Forty children (mean age was 80 ± 40 months) with FHF secondary to AVH received NAC. Majority were males (n=25; 63%). Vomiting (75%) and jaundice (65%) were the main presenting symptoms, one-third had hypoglycemic, while 40% had altered sensorium at the time of admission. There was significant statistical difference in liver enzymes and prothrombin time on admission comparing at discharge in children received NAC (p < 0.001). Fifteen (38%) children died. Severe vomiting {Odds Ratio (OR) 0.22, 95% Confidence Interval (CI) 0.05 - 0.8}, jaundice (OR 9.3, CI 1.1 - 82.6), inotropic support (OR 20.6, CI 3.5 - 118.3) and mechanical ventilation (OR 4.3, CI 1.1 - 16.6) at the time of admission are associated with risk factors for mortality in children with FHF secondary to AVH.
  
  
  CONCLUSIONS
  NAC used in children with FHF secondary to AVH is associated with markedly improved liver function tests and recovery. FHF with complications is high risk for mortality.
authors.affiliation: Department of Paediatrics and Child Health, The Aga Khan University Hospital, Karachi.
authors.forename: Ali Faisal
authors.initials: AF
authors.lastname: Saleem
authors.affiliation: Department of Paediatrics and Child Health, The Aga Khan University Hospital, Karachi.
authors.forename: Qalab
authors.initials: Q
authors.lastname: Abbas
authors.affiliation: Department of Paediatrics and Child Health, The Aga Khan University Hospital, Karachi.
authors.forename: Anwar Ul
authors.initials: AU
authors.lastname: Haque
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000208:Acute Disease; D000293:Adolescent; D000704:Analysis of Variance; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007223:Infant; D007565:Jaundice / Q000209:etiology; D017114:Liver Failure, Acute / Q000188:drug therapy* / Q000209:etiology; D008111:Liver Function Tests; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology
chemical_list: D000998:Antiviral Agents; D000111:Acetylcysteine