1082 N-Acetylcysteine: A Novel Agent for Patients With Ischemic Hepatopathy

Abstract

INTRODUCTION: Acute ischemic hepatopathy is diffuse hepatic injury from hypoperfusion leading to a profound elevation in aminotransferases; it accounts for 1 to 2.5 percent of patients admitted to an intensive care unit. Recent studies showed that N-Acetylcysteine (NAC) provides mortality benefit and improves transplant-free survival in patients with non-acetaminophen induced liver injury, however no studies have shown its effects on ischemic hepatopathy. In studies utilizing murine models, NAC was found beneficial in ischemic injury given its anti-apoptotic, anti-inflammatory, and anti-oxidant properties. We aim to evaluate the trend of hepatic function tests, use of vasopressor requirements, and length of intensive care stay for patients admitted with ischemic hepatopathy who received the 72-hour-NAC protocol compared to those who did not. METHODS: In this retrospective single-center study, we identified adult patients with ischemic hepatopathy from cardiogenic, septic, or hypovolemic shock within a three year period. Chart review was performed and data trends in transaminases, bilirubin, coagulation tests, creatinine, vasopressor requirements, and the number of intensive care days were collected. Univariate analysis was performed. RESULTS: A total of 30 patients with ischemic hepatopathy were included; 15 patients received the 72-hour NAC protocol and 15 patients did not. No differences were found in median age or gender between both groups. A statistical improvement in the aspartate aminotransferase (AST) (-93.6% vs -72.8%, P = 0.003) and creatinine (-38.2% vs 19.3%, P = 0.000) was observed in the NAC group compared to the non-NAC group. Median vasopressor days were fewer and length of stay was higher in the NAC group compared to the control, but not statistically significant. There was no significant difference in mortality. CONCLUSION: Based on our data, NAC use is associated with improved renal function at 72 hours. The NAC group appeared to have a more rapid improvement of AST, alanine aminotransferase (ALT), and bilirubin compared to the control group; however, only AST reached statistical significance, likely due to the small sample size. This pilot study shows potential clinical benefit of NAC as a treatment modality for ischemic hepatopathy. Higher-powered, randomized controlled trials are needed to further validate these observations.