Evaluation of the Association of N-Acetylcysteine and Mortality in Non-Acetaminophen-Induced Acute Liver Failure
In brief
IV N-acetylcysteine was linked to 13 fewer deaths per 100 patients with acute liver failure
In this retrospective study of 200 adults with non-acetaminophen acute liver failure, 21-day in-hospital mortality was 48.9% with IV N-acetylcysteine and 62.1% without it. The treatment was not linked to faster lab recovery or shorter hospital stays, and the observational design cannot establish that it caused the lower mortality; larger prospective studies are needed.
- Journal
- Journal of intensive care medicine (Q1)
- Published
- 29 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Shelley Shen, Tsz Hin Ng, Christopher Giuliano, Amina Ammar, Corinne Songer, Mitesh Doshi, et al.
- PMID
- 42957980
- DOI
- 10.1177/08850666261503884
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 31 October 2026): Potential NAC benefit in non-acetaminophen acute liver failure
Abstract
PurposeNon-acetaminophen-induced acute liver failure (NAI-ALF) is associated with high mortality, with limited treatment options beyond supportive care and liver transplantation. While intravenous (IV) N-acetylcysteine (NAC) is the standard of care in acetaminophen-induced ALF, its benefit in NAI-ALF remains uncertain. Therefore, the purpose of this study is to evaluate the effect of IV NAC on in-hospital mortality.MethodsWe conducted a retrospective cohort study that included adult patients with NAI-ALF. Inverse probability of treatment weighting (IPTW) based on baseline demographics, severity of ALF, comorbidity burden, and etiology of ALF was conducted to balance the two groups. The primary outcome was all-cause in-hospital mortality at 21 days. Secondary outcomes included time to INR normalization, time to liver function test (LFT) normalization, and hospital length of stay.ResultsA total of 200 patients were included in the study, with 85 patients in the NAC group and 115 in the non-NAC group. After IPTW, groups were balanced with standardized mean differences of <0.1 for all covariates. IV NAC was associated with lower in-hospital mortality at 21 days (48.9% vs 62.1%, P < .01), with an odds ratio of 0.59 (95% CI 0.39 - 0.88). No difference was observed in time to INR normalization [HR 1.49 (95% CI 0.87 - 2.56, P = .15)], time to LFT normalization [HR 1.12 (95% CI 0.72 - 1.74, P = .61)], and length of hospital stay (11.9 vs 15.1 days, P = .84).ConclusionFor patients with NAI-ALF, IV NAC administration was associated with a reduction in in-hospital mortality at 21 days. These findings suggest NAC could play a role in the management of patients with NAI-ALF. Larger prospective studies are needed to further clarify the role of NAC in this population.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.