Document Detail

Improvements in hepatic serological biomarkers are associated with clinical benefit of intravenous N-acetylcysteine in early stage non-acetaminophen acute liver failure.
MedLine Citation:
PMID:  23325162     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: N-acetylcysteine (NAC) improves transplant-free survival in early coma grade (I-II) patients with non-acetaminophen induced acute liver failure (ALF). We determined whether the clinical benefit was associated with improvements in hepatic function.
METHODS: In a prospective, double blind trial, 173 ALF patients without evidence of acetaminophen overdose were stratified by coma grade (I-II vs. III-IV) and randomly assigned to receive either intravenous NAC or dextrose (placebo) for 72 h, resulting in four patient groups. INR, ALT, bilirubin, creatinine, and AST obtained on admission (day 1) and subsequent days (days 2-4) were used for secondary analysis performed by fitting longitudinal logistic regression models to predict death or transplantation or transplantation alone.
RESULTS: Treatment group and day of study in models including bilirubin or ALT were predictors of transplantation or death (maximum p < 0.03). Those patients with early coma grade who were treated with NAC showed significant improvement in bilirubin and ALT levels when compared to the other three groups (maximum p < 0.02 for NAC 1-2 vs. the 3 other treatments) when predicting death or transplantation. Treatment group, day of study, and bilirubin were predictors of transplantation (maximum p < 0.03) in ALF patients.
CONCLUSION: The decreased risk of transplantation or death or of transplantation alone with intravenous NAC in early coma grade patients with non-acetaminophen induced ALF was reflected in improvement in parameters related to hepatocyte necrosis and bile excretion including ALT and bilirubin, but not in INR, creatinine, or AST. Hepatic recovery appears hastened by NAC as measured by several important lab values.
Sundeep Singh; Linda S Hynan; William M Lee;
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2013-01-17
Journal Detail:
Title:  Digestive diseases and sciences     Volume:  58     ISSN:  1573-2568     ISO Abbreviation:  Dig. Dis. Sci.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-05-22     Completed Date:  2013-07-22     Revised Date:  2014-05-07    
Medline Journal Info:
Nlm Unique ID:  7902782     Medline TA:  Dig Dis Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1397-402     Citation Subset:  AIM; IM    
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MeSH Terms
Acetylcysteine / therapeutic use*
Biological Markers / blood*
Coma / blood,  etiology,  mortality,  therapy
Double-Blind Method
Free Radical Scavengers / therapeutic use*
Infusions, Intravenous
Liver Failure, Acute / blood*,  complications,  mortality,  therapy*
Liver Function Tests
Liver Transplantation
Prospective Studies
Grant Support
Reg. No./Substance:
0/Biological Markers; 0/Free Radical Scavengers; WYQ7N0BPYC/Acetylcysteine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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