eISSN: 1897-4317
ISSN: 1895-5770
Gastroenterology Review/Przegląd Gastroenterologiczny
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1/2022
vol. 17
 
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abstract:
Systematic review/Meta-analysis

N-acetylcysteine in non-acetaminophen-induced acute liver failure: a systematic review and meta-analysis of prospective studies

Waseem Amjad
1
,
Paul Thuluvath
2, 3
,
Muhammad Mansoor
4
,
Abhishek Dutta
5
,
Farman Ali
6
,
Waqas Qureshi
7

  1. Department of Internal Medicine, Albany Medical Center, Albany, NY, USA
  2. Department of Digestive Disease, Mercy Medical Center, Baltimore, MD, USA
  3. Department of Gastroenterology, University of Maryland, Baltimore, MD, USA
  4. Department of Gastroenterology, Albany Medical Center, Albany, NY, USA
  5. Department of Critical Care, Memorial Sloan Kettering, New York, NY, USA
  6. Department of Internal Medicine, Beaumont Hospital, Dearborn, MI, USA
  7. Department of Cardiology, University of Massachusetts, Worchester, MA, USA
Gastroenterology Rev 2022; 17 (1): 9–16
DOI: https://doi.org/10.5114/pg.2021.107797
Online publish date: 2021/07/14
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Introduction
There are discordant reports on N-acetylcysteine (NAC) efficacy in non-acetaminophen acute liver failure (ALF).

Aim
To determine whether NAC is beneficial in non-acetaminophen ALF.

Material and methods
We performed a systemic review and meta-analysis of published data to address the question. PubMed and MEDLINE were searched using the terms non-acetylcysteine and ALF due to non-acetaminophen, viral infection, drug-induced or autoimmune hepatitis. The primary outcome was overall mortality. Secondary outcomes were transplant-free survival and length of hospital stay. Risk ratios were calculated using a random model for meta-analysis.

Results
A total of 672 patients were included in this meta-analysis from 5 prospective studies (NAC group: n = 334; control group: n = 338). Viral hepatitis (45.8% vs. 32.8%) followed by drug-induced liver injury (24.6% vs. 27.5%), indeterminate cause (13.2% vs. 21.6%) and autoimmune hepatitis (6.6% vs. 8.9%) were the most common etiologies of ALF in the treatment group and control group respectively. Treatment with N-acetylcysteine improved the transplant-free survival significantly (55.1% vs. 28.1%; RR = 0.56; 95% CI: 0.33–0.94) whereas the overall survival was not improved with NAC (71% vs. 59.8%; RR = 0.73; 95% CI: 0.48–1.09). The NAC treatment was associated with shorter hospital stay (Standard difference in means (SMD) = –1.62; 95% CI: –1.84 to –1.40, p < 0.001).

Conclusions
The treatment of patients with acute liver failure with N-acetylcysteine improved transplant-free survival and length of stay.

keywords:

liver failure, N-acetylcysteine, transplant-free survival, mortality
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