Role of N-acetylcysteine in adults with non-acetaminophen-induced acute liver failure in a center without the facility of liver transplantation

Purpose: We aimed to study the role of N-acetylcysteine (NAC) in non-acetaminophen-induced acute liver failure (NAI-ALF). Methods: A total of 47 adult patients were prospectively enrolled with NAI-ALF (group 1 or NAC group) and oral NAC was given. The primary outcome was reduction in mortality with the use of NAC in NAI-ALF. The secondary outcomes were to evaluate safety of NAC and to assess factors predicting mortality. We compared these results with records of NAI-ALF patients admitted in our hospital from 2000 to 2003 (n = 44) who were not given NAC (group 2 or historical controls). Results: The two groups were comparable for the etiology of ALF, prothrombin time (PT), alanine aminotransferase, creatinine, albumin, etc. The mean age in group 1 was 27.7 ± 11.8 years and in group 2 37.5 ± 18.8 years (P = 0.004). Bilirubin was 20.63 ± 11.03 and 14.36 ± 8.90 mg/dl in groups 1 and 2, respectively (P = 0.004). There were 8 (17%) and 1 (2.3%) pregnant ALF women with acute hepatitis E virus (HEV) infection in groups 1 and 2, respectively (P = 0.031). All patients were given supportive care, including mechanical ventilation. A total of 34 (37.36%) patients survived; 22 (47%) in group 1 (NAC group) and 12 (27%) in group 2 (controls) (P = 0.05). On multivariable regression analysis, patients not given NAC (odds ratio [OR] = 10.3, 95% confidence interval [CI] = 1.6-65.7), along with 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), and interval between jaundice and hepatic encephalopathy (OR = 5.0, 95% CI = 1.3-19.1) were independent predictors of mortality. Conclusions: The use of NAC causes reduction in NAI-ALF mortality and its use was safe.