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Hepatol Int. 2010 June; 4(2): 535.
Published online 2010 February 23. doi:  10.1007/s12072-010-9171-9
PMCID: PMC2900556

N-Acetylcysteine in non-acetaminophen-induced acute liver failure

Dear sir,

I did read with a great interest the recently published article by Mumtaz et al. [1]. The article has important favorable results supporting the use of N-acetylcysteine (NAC) in non-acetaminophen-induced acute liver failure. The authors reported a significantly higher survival rate of 47% without liver transplantation in patients given NAC [1]. One of the major concerns with this study is the complete neurological recovery rate of these patients. Direct measurement of cerebral perfusion and intracranial pressures was not provided, and 68.1% of the patients in this group had grade 3–4 encephalopathy [2]. As all the physicians who treat these patients agree, the prediction of spontaneous recovery in fulminant hepatic failure without transplantation is the major challenge. That is why, some discriminatory factors of spontaneous recovery should be defined by authors, for example, Clichy criteria (factor V level <50%), before the conclusion can be drawn [3].


Levent Filik


1. Mumtaz K, Azam Z, Hamid S, Abid S, Memon S, Ali Shah H, et al. Role of N-acetylcysteine in adults with non-acetaminophen-induced acute liver failure in a center without a facility of liver transplantation. Hepatol Int. doi:10.1007/s12072-009-9151-0 [PMC free article] [PubMed]
2. Polson J, Lee WM. AASLD Paper: the management of acute liver failure. Hepatology. 2005;41:1179–1197. doi: 10.1002/hep.20703. [PubMed] [Cross Ref]
3. Izumi S, Langley PG, Wenden J, Ellis AJ, Pernambuco R, Hughes RD, et al. Coagulation factor V levels as a prognostic indicator in fulminant hepatic failure. Hepatology. 1996;23:1507–1511. doi: 10.1002/hep.510230630. [PubMed] [Cross Ref]

Articles from Hepatology International are provided here courtesy of Asian Pacific Association for the Study of the Liver