Intravenous N-acetylcysteine in acute liver failure associated with dengue infection

Abstract

BACKGROUND: Acute liver failure is rare in dengue but has a poor outcome. N-acetylcysteine (HAC) improves survival in early stage non-acetaminophen acute liver failure. However, its usefulness has not been established in dengue associated acute liver failure. OBJECTIVES: To determine the benefit of intravenous NAC in acute liver failure due to dengue. Methods; Outcome of consecutive adult patients with serologically confirmed dengue infection associated acute liver failure (INR>1.5 with encephalopathy) was retrospectively analysed. They received NAC by intravenous infusion for 72 hours in addition to supportive management. None had taken paracetamol above the therapeutic dose, used hepatotoxic drugs or abused alcohol. Serology for Hepatitis A, B, C, leptospira, and rickettsiae was negative. All patients had negative computerized tomography of the brain. RESULTS: There were 18 patients, (10 females) aged 22-68 years. 11 had dengue hemorrhagic fever (grade 1 and 2), 7 had dengue shock syndrome, 12 had pleural effusions and 8 had ascites. 15 patients had acute liver failure and 3 acute on chronic liver failure (previously diagnosed cirrhotics). 14 patients had early stage hepatic encephalopathy (coma grades I-II), and 4 had advanced encephalopathy (coma grades III-IV). All patients with coma grades l-II recovered completely, while 3 with coma grades III-IV died. None had adverse effects attributable to NAC. CONCLUSION: These preliminary observations suggest that using intravenous NAC in the early stages of dengue associated liver failure is safe and may benefit patients.