Factors influencing survival in patients with non-acetaminophen acute liver failure receiving continuous intravenous N-acetylcysteine
Keywords:
non-acetaminophen induced acute liver failure, factors, survival, IV N-acetylcysteineAbstract
Background: The management of acute liver failure (ALF), particularly non-acetaminophen induced acute liver failure (NAI-ALF), presents a significant challenge in healthcare settings where liver transplantation facilities are limited. Understanding the factors that contribute to the successful use of continuous intravenous N-acetylcysteine (IV NAC) could be crucial for optimizing treatment strategies and improving patient survival rates.
Objective: This study aimed to identify the factors associated with the 21-day survival rate of NAI-ALF patients who received continuous IV NAC at hospital with limited liver transplantation capabilities.
Methods: This retrospective cohort study was conducted at Nakornping hospital from January 1, 2022, to December 31, 2024. Data were collected from the medical records of all NAI-ALF patients who received IV NAC and had been followed up for 21-day survival outcome.
Results: Out of 198 patients with acute liver failure (ALF) who received IV NAC, 74 met the inclusion criteria (37.37%). Of these, 50 (67.57%) were male, a median age was 44 years (IQR 34-62) and HE grades III-IV were observed in 16 patients (21.62%). The primary etiology of ALF was drug or toxin-induced (n = 33, 44.59%). The median duration of IV NAC administration was 96 hours (IQR 24 - 192). The overall 21-day survival rate was 56.75%. Non-serious adverse drug events occurred in 3 events (4.41%). Analysis revealed that only factor associated with improved survival was continuous IV NAC administration ≥ 72 hours (AOR = 19.573, 95% CI 4.509 - 84.961, p < 0.001). Factors associated with reduced survival were NAI-ALF caused by viral hepatitis infection (AOR = 0.098, 95% CI 0.012 - 0.774, p = 0.028) and requirement for mechanical ventilation (AOR = 0.176, 95% CI 0.043-0.713, p = 0.015).
Conclusion: In hospital settings where liver transplantation is unavailable, the administration of continuous intravenous N-acetylcysteine (IV NAC) for more than 72 hours may serve as a crucial strategy to improve survival rate in patients with Non-Acetaminophen Induced Acute Liver Failure (NAI-ALF). This approach is particularly effective in patients whose conditions have not yet progressed to a critical stage.
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