Amjad Waseem, Thuluvath Paul, Mansoor Muhammad, Dutta Abhishek, Ali Farman, Qureshi Waqas
Department of Internal Medicine, Albany Medical Center, Albany, NY, USA.
Department of Digestive Disease, Mercy Medical Center, Baltimore, MD, USA.
Prz Gastroenterol. 2022;17(1):9-16. doi: 10.5114/pg.2021.107797. Epub 2021 Jul 14.
There are discordant reports on N-acetylcysteine (NAC) efficacy in non-acetaminophen acute liver failure (ALF).
To determine whether NAC is beneficial in non-acetaminophen ALF.
We performed a systemic review and meta-analysis of published data to address the question. PubMed and MEDLINE were searched using the terms non-acetylcysteine and ALF due to non-acetaminophen, viral infection, drug-induced or autoimmune hepatitis. The primary outcome was overall mortality. Secondary outcomes were transplant-free survival and length of hospital stay. Risk ratios were calculated using a random model for meta-analysis.
A total of 672 patients were included in this meta-analysis from 5 prospective studies (NAC group: = 334; control group: = 338). Viral hepatitis (45.8% vs. 32.8%) followed by drug-induced liver injury (24.6% vs. 27.5%), indeterminate cause (13.2% vs. 21.6%) and autoimmune hepatitis (6.6% vs. 8.9%) were the most common etiologies of ALF in the treatment group and control group respectively. Treatment with N-acetylcysteine improved the transplant-free survival significantly (55.1% vs. 28.1%; RR = 0.56; 95% CI: 0.33-0.94) whereas the overall survival was not improved with NAC (71% vs. 59.8%; RR = 0.73; 95% CI: 0.48-1.09). The NAC treatment was associated with shorter hospital stay (standard difference in means (SMD) = -1.62; 95% CI: -1.84 to -1.40, p < 0.001).
The treatment of patients with acute liver failure with N-acetylcysteine improved transplant-free survival and length of stay.
关于N - 乙酰半胱氨酸（NAC）在非对乙酰氨基酚急性肝衰竭（ALF）中的疗效存在不一致的报道。
确定NAC对非对乙酰氨基酚ALF是否有益。
我们对已发表的数据进行了系统评价和荟萃分析以解决该问题。使用非乙酰半胱氨酸和由非对乙酰氨基酚、病毒感染、药物性或自身免疫性肝炎引起的ALF等术语在PubMed和MEDLINE中进行检索。主要结局是总体死亡率。次要结局是无移植生存和住院时间。使用随机模型进行荟萃分析计算风险比。
本荟萃分析共纳入了来自5项前瞻性研究的672例患者（NAC组：n = 334；对照组：n = 338）。病毒性肝炎（45.8%对32.8%），其次是药物性肝损伤（24.6%对27.5%）、病因不明（13.2%对21.6%）和自身免疫性肝炎（6.6%对8.9%）分别是治疗组和对照组中ALF最常见的病因。N - 乙酰半胱氨酸治疗显著改善了无移植生存（55.1%对28.1%；RR = 0.56；95%CI：0.33 - 0.94），而NAC并未改善总体生存（71%对59.8%；RR = 0.73；95%CI：0.48 - 1.09）。NAC治疗与较短的住院时间相关（平均标准差（SMD）= -1.62；95%CI： -1.84至 -1.
