H-13
INTRAVENOUS N-ACETYLCYSTEINE ADMINISTRATION IN ACUTE LIVER INJURY
Huynh Q*, Chen J, Marfo K
Montefiore Medical Center the University Hospital for Albert Einstein College of Medicine
111 East 210th Street, Bronx, New York 10467
Purpose
Acute liver failure (ALF) secondary to acute liver injury (ALI) is associated with high mortality
rate and frequent need for transplantation. N-acetylcysteine (NAC) can prevent liver damage
caused by acetaminophen (APAP) when given within 24 hours. In non-APAP ALI, NAC may
improve hemodynamics, tissue oxygen delivery, and modify disease progression. We sought to
evaluate a clinical protocol of NAC administration and its therapeutic benefits in ALI. Clinical
outcomes of these patients with APAP induced ALI compared to patients with non-APAP
induced ALI will be evaluated.
Methods
Medical records of adult patients who received continuous NAC infusion between August 1,
2010 and July 31, 2012 for ALI were retrospectively reviewed for baseline demographic
characteristics including etiology of ALI, MELD scores on days 1 and 7, duration of therapy,
total dose administered, and concomitant medications. Clinical outcomes after 7 days of therapy
including changes in liver function tests, INR, serum creatinine, survival at discharge and 30days, and transplant-free survival were collected. Cost utilization analysis of treatment with NAC
was determined based on patients’ length of hospital stay and drug acquisition cost. Due to the
retrospective nature and design of the study, institutional review board and informed consent was
not necessary to obtain.
Summary of Results
46 patients in the APAP and 100 in the non-APAP groups received continuous IV NAC infusion
for ALI for a mean duration of 25.9 and 29.9 hours, respectively with 48 (32.9%) of patients
receiving >24 hours of therapy and 9 (6.2%) receiving >72 hours. Patients with ALI secondary to
non-APAP etiologies were older, had more renal impairment, higher MELD scores, and longer
LOS. IV NAC was well tolerated with no interruption of therapy due to adverse events and
APAP and non-APAP ALI proved comparable in regards to reduction in AST and ALT. there was
no difference in INR, serum creatinine, and MELD score observed in both groups. Survival was
97.8% and 82.0% at discharge, 96.2% and 70.0% at 7 days, and 92.9% and 65.4% at 30 days in
the APAP and non-APAP groups, respectively with transplant-free survival valuing at 97.8% and
77.0% in the APAP and non-APAP groups, respectively. Only 1 in the APAP and 23 in the nonAPAP groups required liver transplants.
Conclusions
IV NAC is indicated to prevent APAP-induced ALI with some data supporting its use in nonAPAP etiologies. Although similar trends in measurable clinical values were seen with the use of
IV NAC in both groups of our study, the lack of rigorous clinical methodology prevents us from
drawing substantial conclusions. Further research must be done to describe the role of IV NAC
in non-APAP ALI.