Use of acetylcysteine in non-acetaminophen induced acute liver failure

Introduction: The purpose of this study is to examine the use of acetylcysteine in patients with non-acetaminophen induced acute liver failure (NAI-ALF) and its effect on liver function. Treatment of acetaminophen toxicity with acetylcysteine is well established and is effective due to its ability to replenish hepatic glutathione. However, acetylcysteine also possesses antioxidant and vasodilating properties.  There is a growing amount of evidence for the potential benefit of it in other causes of acute liver failure (ALF) as well. Our study examines this by comparing liver function markers pre- and post- acetylcysteine treatment in NAI-ALF patients.

Objectives: Primary outcome is to examine acetylcysteine's effect on the patients' liver function by comparing pre and post treatment AST/ALT, bilirubin, INR, PT, and MELD scores. Secondary outcomes also studied include patients' survival, rate of liver transplant, transplant free survival, and length of stay.

Study Design: Retrospective chart review of patients admitted between December 5, 2012 and September 26, 2015. 

Methods: Single academic medical center generated report of all patients who received acetylcysteine using the electronic medical records system. Inclusion criteria are: adults (greater than eighteen years old), treated with acetylcysteine (oral or intravenous), and meet the American Association for the Study of Liver Diseases' (AASLD) classification of ALF; defined by evidence of abnormal coagulation (INR ≥ 1.5) and any degree of mental alteration (encephalopathy). Exclusion criteria are: acute liver failure due to acetaminophen toxicity or shock/ischemic liver.

Results: 20 patients are enrolled with a goal N=45. Baseline characteristic averages and ranges, respectively, are: age (54.7, 28-86); AST (1175, 54-5473); ALT (724, 25-3305); bilirubin (12.5, 0.5-30.8); INR (3.3, 1.1-10.5); PT (32.9, 11.4-113.9); SCr (3.0, 0.8-8.9); MELD (35.2, 19-52.4).

Conclusions: Study in progress, 100% likelihood of completion by presentation date.