Source:http://linkedlifedata.com/resource/pubmed/id/18161828
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| Predicate | Object |
|---|---|
| rdf:type | |
| lifeskim:mentions | |
| pubmed:issue |
1
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| pubmed:dateCreated |
2008-1-2
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| pubmed:abstractText |
Acute liver failure (ALF) carries a high mortality in children. N-acetylcysteine (NAC), an antioxidant agent that replenishes mitochondrial and cytosolic glutathione stores, has been used in the treatment of late acetaminophen-induced ALF and non-acetaminophen-induced ALF. In our unit, NAC was introduced as additional treatment for non-acetaminophen-induced ALF in 1995. The aim of this study was to evaluate the safety and efficacy of NAC in children with ALF not caused by acetaminophen poisoning. A retrospective review of medical records of 170 children presenting with nonacetaminophen-induced ALF between 1989 and 2004 was undertaken. ALF was defined as either international normalized ratio of prothrombin time (INR) > 2 and abnormal liver function or INR >1.5 with encephalopathy and abnormal liver function. Children were divided into the following groups: Group 1 (1989-1994), standard care (n = 59; 34 [58%] male; median age 2.03 yr, range 0.003-15.8 yr); and Group 2 (1995-2004), standard care and NAC administration (n = 111; 57 [51%] male; median age 3.51 yr, range 0.005-17.4 yr). NAC was administered as a continuous infusion (100 mg/kg/24 hours) until INR < 1.4, death, or liver transplantation (LT). The median duration of NAC administration in Group 2 was 5 (range, 1-77) days. Complications were noted in 8 (10.8%) children: rash in 3, arrhythmia in 3, and dizziness and peripheral edema in 1. One child had an allergic reaction (bronchospasm) and NAC was stopped. A total of 41 (71%) children in Group 1 vs. 85 (77%) in Group 2 required admission to intensive care, P = not significant (ns). The length of intensive care stay was 6 (range, 1-58) days in Group 1 vs. 5 (range, 1-68) days in Group 2, P = ns and length of hospital stay was 25 (range, 1-264) days vs. 19 (range, 1-201) days, P = 0.05. The 10-yr actuarial survival was 50% in Group 1 compared to 75% in Group 2, P = 0.009. Survival with native liver occurred in 13 (22%) in Group 1 vs. 48 (43%) in Group 2, P = 0.005; 15 (25%) in Group 1 died without transplant vs. 21 (19%) in Group 2, P = ns; and LT was performed in 32 (54%) vs. 42 (38%), P = ns. Death after transplantation occurred in 15 (39%) in Group 1 vs. 8 (16%) in Group 2, P = 0.02. In conclusion, NAC is safe in non-acetaminophen-induced ALF. In this retrospective study NAC was associated with a shorter length of hospital stay, higher incidence of native liver recovery without transplantation, and better survival after transplantation.
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| pubmed:commentsCorrections | |
| pubmed:language |
eng
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| pubmed:journal | |
| pubmed:citationSubset |
IM
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| pubmed:chemical | |
| pubmed:status |
MEDLINE
|
| pubmed:month |
Jan
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| pubmed:issn |
1527-6465
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| pubmed:author | |
| pubmed:copyrightInfo |
(c) 2007 AASLD.
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| pubmed:issnType |
Print
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| pubmed:volume |
14
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| pubmed:owner |
NLM
|
| pubmed:authorsComplete |
Y
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| pubmed:pagination |
25-30
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| pubmed:meshHeading |
pubmed-meshheading:18161828-Acetaminophen,
pubmed-meshheading:18161828-Acetylcysteine,
pubmed-meshheading:18161828-Adolescent,
pubmed-meshheading:18161828-Analgesics, Non-Narcotic,
pubmed-meshheading:18161828-Child,
pubmed-meshheading:18161828-Child, Preschool,
pubmed-meshheading:18161828-Female,
pubmed-meshheading:18161828-Follow-Up Studies,
pubmed-meshheading:18161828-Free Radical Scavengers,
pubmed-meshheading:18161828-Great Britain,
pubmed-meshheading:18161828-Humans,
pubmed-meshheading:18161828-Infant,
pubmed-meshheading:18161828-Infant, Newborn,
pubmed-meshheading:18161828-Infusions, Intravenous,
pubmed-meshheading:18161828-Liver Failure, Acute,
pubmed-meshheading:18161828-Male,
pubmed-meshheading:18161828-Retrospective Studies,
pubmed-meshheading:18161828-Survival Rate,
pubmed-meshheading:18161828-Treatment Outcome
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| pubmed:year |
2008
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| pubmed:articleTitle |
Safety and efficacy of N-acetylcysteine in children with non-acetaminophen-induced acute liver failure.
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| pubmed:affiliation |
Paediatric Liver Centre, King's College London School of Medicine at King's College Hospital, London, UK.
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| pubmed:publicationType |
Journal Article,
Comparative Study
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