Article Text

PDF

PWE-130 Effect Of N Acetylcysteine (NAC) in Hypoxia Induced Liver Injury (HILI)–A Randomized Placebo Control Clinical Trial
  1. P Basu1,
  2. N J Shah2,
  3. S Farhat3,
  4. R Siriki1,
  5. K Mittimanj1,
  6. M Rahaman1,
  7. S Atluri1
  1. 1Forest Hills Hospital, Hofstra North Shore-LIJ School of Medicine
  2. 2James J Peters VA Medical Center, Mount Sinai School of Medicine, New York
  3. 3Columbia School of Physicians and Surgeons, NY, New York, United States

Abstract

Introduction HILI is common with a prevalence of 10% in US. Transient shift of intra hepatic hemodynamic compromise leads to tissue hypoxia and induces hypoxia induced protein (HIP), heat shock protein 70 (HSP24.70), Endothelial reticular stress (ER) leading to reperfusion injury (RI). Dramatic rise of transaminases, drastic reversal with restoration of perfusion in weeks follows. In cirrhotics HILI requires liver transplantation. This study evaluated spontaneous recovery and salvage in HILI utilising NAC.

Methods Sixty patients (n = 60) with mean arterial pressure (MAP) < 35% and normal LFTs at base line. Group A (n = 28) chronic liver disease (CLD) [alcohol-11/28 (39%), NASH-9/28 (32%), Hepatitis C-4/28 (14%), hepatitis B-2/28 (7%), PBC-1/28 (3%), AIH-1/28 (3%). Group B (n = 32) [respiratory failure-12/32 (37%), CHF-8/32 (25%), CVA-2/32 (6%), sepsis-6/32 (19%), post op-4/32 (12%)]. Randomized into Placebo group- A1 (14) & B1 (16) and IV NAC for 48 hours - A2 (14) & B2 (16). Serum Transaminases, Bilirubin, INR, Creatinine and MELD score at 0, 3rd, 6th, 9th and 12th days with MAP and modified Sequential Organ Failure Assessment (SOFA) Score. All patients were allowed standard of care (SOC) and resuscitations if needed.

Exclusions: Organ transplant, Septic shock, Hemodialysis, cancer, acute myocardial Infarct, Tylenol injury, acute viral hepatitis and organ trauma.

Results Placebo groups A1, B1: Normalized A1-[LFTs- on 3rd day-(7%), 6th day-(21%), 9th day-(36%) and 12th day-(21%). 1/14(7%) died]. B1(CLD)[ LFTs 3rd day-(19%) 6th (44%) 9 th (25%),2/16(6%) died of sepsis] NAC Groups A2[normalised LFTs 3rd (57%)6th day-(43%) 9 th day (25%), (7%)-one died ] B2 (CLD)[Normalized LFTs- 3rd day-(63%), 6th day-(25%) 9 th1/16(6%), one died]

Conclusion This Study postulates that IV NAC (A2, B2) has efficient spontaneous recovery and salvage in non-CLD sub group B2 (63%) > A2(57%) in day 3, in CLD NAC (A2) > placebo (A1) clinical recovery over placebo at 3rd day, (44%) over (36%) - 6th day. Larger trial need to establish the routine usage of IV NAC in HILI.

Disclosure of Interest None Declared.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.