ArticleAnnals of gastroenterology2021
Role of N-acetylcysteine in non-acetaminophen-related acute liver failure: an updated meta-analysis and systematic review.
Article in Annals of gastroenterology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
37 citing papers in PubMed, 2 syntheses or guidelines pooled it, 57 citations in OpenAlex.
- APASL clinical practice guidelines on the management of acute kidney injury in acute-on-chronic liver failure.Hepatology international · 2024Guideline
- N-Acetylcysteine for the Management of Non-Acetaminophen Drug-Induced Liver Injury in Adults: A Systematic Review.Frontiers in pharmacology · 2022Pooled it
- Integrated transcriptomic and experimental validation reveal that N‑acetylcysteine ameliorates acute liver failure through multi‑target synergistic regulation of pyroptosis and related signaling networks.Naunyn-Schmiedeberg's archives of pharmacology · 2026Article
- Antioxidant therapy, N-acetyl-L-cysteine, effects on pancreatic β cells: therapeutic promise or potential harm?Endocrinology · 2026Review
- Acute cholestatic jaundice and coagulopathy in a middle-aged woman.Internal and emergency medicine · 2026Article
- Severe Dengue-Associated Hepatitis in an Adolescent Treated With Oral Acetylcysteine: A Case Report.Cureus · 2026Article
- Epstein-Barr Virus (EBV) Hepatitis Treated With N-Acetylcysteine: Placebo Versus True Effect.Cureus · 2026Article
- Antiseizure Treatments and Liver Injury: Expect (and Prevent) the Unexpected.Epilepsy currents · 2026Review
- RAC1 as a novel therapeutic target for acute liver failure.JHEP reports : innovation in hepatology · 2025Article
- The neuroprotective effect of N-acetylcysteine by regulating inflammation and expression of TNF-α and ERK gene expression in the rats exposed to different doses of cadmium.Molecular biology reports · 2025Article
- N-acetylcysteine reduces the hepatic complications of social isolation stress through modulation of interleukin 1 and 6 gene expression and liver enzymes in mice.Scientific reports · 2025Article
- Management of non-Cardiac Organ Failure in cardiogenic shock.American heart journal plus : cardiology research and practice · 2025Article
- Cell therapy for liver disorders: past, present and future.Nature reviews. Gastroenterology & hepatology · 2025Review
- Oxidative Stress Early After Hematopoietic Stem Cell Transplant.Transplantation and cellular therapy · 2025Article
- Article
- Diagnosis and management of pediatric acute liver failure: consensus recommendations of the Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN).Hepatology international · 2024Review
- Adenosine kinase protects against acetaminophen-induced acute liver injury by activating autophagy in hepatocytes.Cell biology and toxicology · 2024Article
- N-acetyl Cysteine Overdose Induced Acute Toxicity and Hepatic Microvesicular Steatosis by Disrupting GSH and Interfering Lipid Metabolisms in Normal Mice.Antioxidants (Basel, Switzerland) · 2024Article
- A Narrative Review of Oxidative Stress and Liver Disease in Pregnancy: The Role of Antioxidants.Cureus · 2024Review
- Review
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe American Association for the Study of Liver Diseases recommends that N-acetylcysteine (NAC) may be beneficial in non-acetaminophen-related drug-induced liver injury. A subsequent review and analysis reported the current evidence to be inconclusive. Herein, we present an updated review and meta-analysis.
methodsWe evaluated prospective, retrospective and randomized controlled trials that compared outcomes in patients of all ages with acute liver failure (defined as abnormal liver enzymes along with elevated international normalized ratio >1.5, with or without hepatic encephalopathy) receiving NAC with the outcomes in a control group. The primary outcome was to compare the overall survival in the 2 groups. Secondary outcomes included difference in length of hospital stay, transplant-free survival, and post-transplant survival.
resultsSeven studies (N=883) that met the inclusion criteria were included in this analysis. The mean age of patients in the NAC group was 21.22 years compared with 23.62 years in the control group. The odds of overall survival were significantly higher in the NAC group than in controls (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.3-2.41). Post-transplant survival (OR 2.44, 95%CI 1.11-5.37) and transplant-free survival were also better in the NAC group than in the control group (OR 2.85, 95%CI 2.11-3.85). Patients in the control group had statistically significant odds of a longer inpatient stay (mean difference 7.79, 95%CI 6.93-8.66).
conclusionIn patients with non-acetaminophen-related acute liver failure, NAC significantly improves overall survival, post-transplant survival and transplant-free survival while decreasing the overall length of hospital stay.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.