The role of N-acetylcysteine in the treatment of non-acetaminophen acute liver failure

Acute liver failure (ALF) is a rare critical illness, usually occurring in patients without underlying liver disease, which can cause significant mortality.[1] ALF has been known by many different terminologies including fulminant hepatic failure, hepatic necrosis, and fulminant hepatitis. While many definitions exist to characterize the process of ALF, the most widely used is the following: hepatic injury with the presence of encephalopathy and a coagulation abnormality usually manifested by an international normalized ratio (INR) of ≥1.5 typically in a patient without preexisting liver disease with an illness of <26 weeks’ duration.[2] The incidence of ALF is estimated at 1–6 per 1 million population in the developed world, and is possibly even higher in the developing world where viral hepatitis is much more prevalent.[3] Survival from ALF has dramatically improved over the last several decades with the advent of liver transplantation and can exceed 65% in the developed world.[4] However, survival remains poor at 50% in some areas of the developing world where access to optimal medical care and liver transplantation may be limited.[5]