eISSN: 2449-8238
ISSN: 2392-1099
Clinical and Experimental Hepatology
Current issue Archive Manuscripts accepted About the journal Editorial board Abstracting and indexing Subscription Contact Instructions for authors Ethical standards and procedures
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
2/2021
vol. 7
 
Share:
Share:
abstract:
Original paper

Efficacy and safety of N-acetylcysteine for the treatment of non-acetaminophen-induced acute liver failure: an updated systematic review and meta-analysis

Haris Jawaid
1
,
Muhammad Mustafa Ali
1
,
Moiz Ullah Khan
1
,
Saad Sami
1
,
Majid Ahmed Shaikh
2

1.
Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
2.
Medical Unit 1, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
Clin Exp HEPATOL 2021; 7, 2: 156-164
Online publish date: 2021/07/13
View full text Get citation
 
PlumX metrics:
Introduction
N-acetylcysteine (NAC) is the treatment of choice for acetaminophen-induced liver injury. However, recent years have witnessed growing interest in its role in the treatment of acute liver failure (ALF) due to other aetiologies. This study aims to determine both its safety and efficacy by pooling data from multiple studies.

Material and methods
A search was conducted for all controlled randomized/non-randomized studies that measured the efficacy and safety of NAC in adult patients with non-acetaminophen-induced acute liver failure (NAI-ALF). Transplant-free survival (TFS) was considered the primary endpoint, while secondary endpoints such as length of hospital stay, and incidence of adverse events during treatment, were included in our analysis. Data were pooled via a random-effects model, I2 was used as a measure of heterogeneity, and publication bias was assessed via a funnel plot.

Results
A total of 3 studies [2 randomized controlled trials (RCTs) and 1 non-randomized cohort] were pooled in this meta-analysis. TFS was significantly higher in patients given NAC, when compared to the placebo/control (PBO) group (RR = 1.54, CI = 1.19-1.98, p = 0.01, I2 = 0.0%). No secondary endpoint was observed to have improved significantly in patients prescribed NAC: length of hospital stay (SMD = –0.405, CI = –1.44-0.63, p = 0.445, I2 = 91.1%), renal failure (RR = 1.01, CI = 0.65-1.57, p = 0.967, I2 = 21.3%), infections (RR = 1.18, CI = 0.91-1.52, p = 0.208, I2 = 2.3%), pulmonary failure (RR = 1.19, CI = 0.57-2.49, p = 0.649, I2 = 84.6%). Minimal side effects were reported in around 10-14% of the patients prescribed NAC.

Conclusions
NAC was shown to significantly improve TFS in adult patients with NAI-ALF, while no significant benefit was observed concerning the secondary endpoints of length of hospital stay and incidence of adverse effects.

keywords:

meta-analysis, liver failure, acetylcysteine, non-acetaminophen, transplantfree survival

Quick links
© 2024 Termedia Sp. z o.o.
Developed by Bentus.