Alcoholism severely affects the liver and can lead to
death. A recent published study assessed
the use of a combination of steroid with N-acetylcysteine in improving survival
in patients with severe alcoholic hepatitis.
Alcohol causes inflammation of the liver resulting
in a condition called alcoholic hepatitis.
Alcoholic hepatitis can be severe enough to result in death of the
patient. Though steroids are currently
used for its treatment, nearly 35% patients die at the end of 6 months of
Researchers investigated whether the addition of a
drug N-acetylcysteine to steroids could possibly improve survival in these
patients. N-acetylcysteine has antioxidant properties and is currently used to
protect the liver during acetaminophen (paracetamol) overdosage. It is also used to reduce thickness of
mucus secreted in certain lung conditions.
The study was conducted on 174 patients in
France. The patients were divided into
two groups: One group was given the steroid prednisolone and the second group
received prednisolone plus N-acetylcysteine. Prednisolone was administered for 28 days for all patients;
patients in the second group also received N-acetylcysteine for the first five
days. The patients underwent initial
examination, laboratory and other tests.
They were followed up for a period of 6 months or till death, whichever
In the study, the percentage of deaths or mortality
rate in the 2 groups, prednisolone - only and prednisolone plus
N-acetylcysteine were 24% and 8% respectively at the end of 1 month, 34% and
22% respectively at the end of 3 months, and 38% and 27% respectively at the
end of 6 months.
At the end of 6 months, 22% deaths from the
prednisolone-only group were due to hepatorenal syndrome in contrast to 9% in
the prednisolone-N-acetylcysteine group. Though more patients in the
prednisolone-only group suffered from infections during the 6-month period,
deaths due to infections were similar in the two groups.
indicate that the combination of prednisolone plus N-acetylcysteine does not
improve survival over 6 months compared to prednisolone alone. There was however, a better survival rate in
the group taking the combination at the end of 1 month. The authors suggest that this improvement could be
partly due to the beneficial effect on hepatorenal syndrome (a condition where
the liver disease results in kidney damage).
Deaths in both groups were found to be associated
with older age, hepatic encephalopathy (brain affliction due to liver disease),
increased prothrombin time (a blood test used to evaluate clotting of blood;
prothrombin is synthesized in the liver, hence its activity is affected by
liver disease), high bilirubin levels at the start of treatment, and failure of
bilirubin levels to decrease by day 14 of treatment.
the study could not demonstrate an improved survival in patients taking a
combination of prednisolone and N-acetylcysteine at the end of 6 months, the
researchers say that it is possible that a larger study with perhaps a longer
duration of injectable N-acetylcysteine followed by oral administration could produce
contrary results. Further studies are required
to establish the benefit of the combination in alcoholic hepatitis, if any.
1. Eric Nguyen-Khac et al for the AAH-NAC Study Group. Glucocorticoids
plus N-Acetylcysteine in Severe Alcoholic Hepatitis. N Engl J Med 2011; 365:1781-1789.