Impact of Intravenous N-Acetylcysteine in Non-Acetaminophen Acute Liver Failure in the Intensive Care Unit Sofiya Sovalska, Stephanie Lesslie, Eric Clayton Memorial Health University Medical Center PGY2 Critical Care - Savannah, GA
Background/Purpose: The 2011 American Association for the Study of Liver Diseases Acute Liver Failure Guidelines briefly discuss the utility of N-acetylcysteine as a potential therapy for non-acetaminophen acute liver failure. Currently, there is a paucity of data regarding the potential benefit of N-acetylcysteine in critically-ill patients. The aim of this observational study is to evaluate the efficacy of intravenous N-acetylcysteine in critically-ill patients with non-acetaminophen acute liver failure compared to patients that did not receive N-acetylcysteine.
Methodology: This retrospective study utilized electronic medical records to identify patients with non-acetaminophen acute liver failure between May 2015 and October 2018.
Results: Of 722 patients screened, 29 patients did not receive N-acetylcysteine and 46 patients did. The change in AST (no N-acetylcysteine -618.6 ± 1488.6 vs. N-acetylcysteine -4001.7 ± 3837.9, p = 0.185) and ALT (no N-acetylcysteine -395.9 ± 720.3 vs. N-acetylcysteine -1057.9 ± 1372.4, p = 0.608) from baseline was not statistically significant when controlled for baseline AST and ALT values. Length of stay, intensive care unit length of stay, and ventilator days were significantly higher in the N-acetylcysteine group. No differences in mortality or safety were observed.
Conclusions: N-acetylcysteine was not associated with a significant reduction in liver function tests in non-acetaminophen acute liver failure, however, this may be due to a small sample size. N-acetylcysteine may continue to be a viable option for patients with non-acetaminophen acute liver failure until more data becomes available.
Presentation Objective: Evaluate the efficacy of N-acetylcysteine in intensive care unit patients with non-acetaminophen acute liver failure.
Self-Assessment: N-acetylcysteine may be hepatoprotective in that it helps restore hepatic stores of what substance?
