Role of N-Acetylcysteine in Non-Acetaminophen-Induced Liver Failure

Acute liver failure carries high mortality, and in resource-limited settings like Pakistan, liver transplantation is often inaccessible, making pharmacologic adjuncts to supportive care important. Prior studies (Nabi et al. 2017; Mumtaz et al. 2009; Parkas et al. 2016) suggest oral NAC may improve survival and shorten hospital stay in non-acetaminophen ALF, though evidence remains limited. This trial will randomly assign eligible patients via computer-generated randomization to receive oral/NG NAC (140 mg/kg every 4 hours for 16 hours, then every 6-8 hours, continued for 3 days) plus standard supportive care, or standard supportive care alone. Standard care includes glucose monitoring, prophylactic antimicrobials, proton pump inhibitors, fluid/electrolyte management, anti-encephalopathy measures as needed, and fresh frozen plasma for bleeding. Patients will be followed for up to 28 days.

Inclusion criteria

• Male or female, aged 18-60 years
• Diagnosed with non-acetaminophen- induced acute hepatic failure (per operational definition/EASL criteria)
• Etiology other than acetaminophen overdose (viral hepatitis HAV/HBV/HEV, non-acetaminophen drug-induced liver injury, or idiopathic)
• No NAC treatment received for current episode prior to enrollment

Exclusion criteria

• History of chronic liver disease or cirrhosis
• Prior severe cardiac, renal, neurological, or infectious disease that could confound outcomes
• Prior liver transplant or current transplant candidacy
• Known allergy/contraindication to NAC
• Pregnant women.