{
    "abstract": "Ischemic hepatitis (IH) following acute variceal bleed (AVB) carries an ominous prognosis. N-Acetylcysteine (NAC), a potent anti-oxidant, may prevent IH by improving tissue oxygen delivery and improving hepatic hypoxia.\nConsecutive cirrhotics with AVB were prospectively randomized to receive either standard of care (SOC) plus NAC intravenously for 72\u00a0h(at 150\u00a0mg/kg/h for 1\u00a0h followed by 12.5\u00a0mg/kg/h for 4\u00a0h, followed by 6.25\u00a0mg/kg for 67\u00a0h) (Group A, n\u2009=\u2009107) or SOC alone (Group B, n\u2009=\u2009107).\nBaseline characteristics were comparable. IH developed more frequently in Gr.B 25(23%) than A-15(14%); p\u2009=\u20090.08). Incidence of IH increased with severity of liver disease. Binary logistic regression analysis showed reduced incidence of IH in Gr.A than B [odds ratio (OR) 0.33, 0.11-0.93] patients after controlling for other significant factors. The incidence of acute kidney injury (AKI) was also reduced in Gr.A [OR 0.34, 0.15-0.75]. Development of IH was significantly associated with increased deaths due to liver failure at 6\u00a0weeks [subdistribution hazard ratio (SHR) 21.6, 7.4-62.8]. On multivariate competing risk analysis, significantly lower deaths due to liver failure (SHR 0.33, 0.11-0.97) were noted in Gr.A than B.\nOne in five patients with acute variceal bleed develops ischemic hepatitis which is associated with worse outcomes. NAC therapy averts deaths due to liver failure by preventing IH and reduces AKI and is, therefore, recommended for cirrhotics with acute variceal bleed.\nClinicaltrials.gov no: NCT02015403.",
    "authors": [
        {
            "affiliation": "Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, VasantKunj, New Delhi, 110070, India.",
            "firstname": "Rakhi",
            "initials": "R",
            "lastname": "Maiwall"
        },
        {
            "affiliation": "Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, VasantKunj, New Delhi, 110070, India.",
            "firstname": "Awinash",
            "initials": "A",
            "lastname": "Kumar"
        },
        {
            "affiliation": "Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.",
            "firstname": "Ajeet Singh",
            "initials": "AS",
            "lastname": "Bhadoria"
        },
        {
            "affiliation": "Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, VasantKunj, New Delhi, 110070, India.",
            "firstname": "Ankur",
            "initials": "A",
            "lastname": "Jindal"
        },
        {
            "affiliation": "Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India.",
            "firstname": "Guresh",
            "initials": "G",
            "lastname": "Kumar"
        },
        {
            "affiliation": "Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.",
            "firstname": "Ankit",
            "initials": "A",
            "lastname": "Bhardwaj"
        },
        {
            "affiliation": "Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India.",
            "firstname": "Jaswinder Singh",
            "initials": "JS",
            "lastname": "Maras"
        },
        {
            "affiliation": "Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, VasantKunj, New Delhi, 110070, India.",
            "firstname": "Manoj Kumar",
            "initials": "MK",
            "lastname": "Sharma"
        },
        {
            "affiliation": "Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, VasantKunj, New Delhi, 110070, India.",
            "firstname": "Barjesh Chandra",
            "initials": "BC",
            "lastname": "Sharma"
        },
        {
            "affiliation": "Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, VasantKunj, New Delhi, 110070, India. shivsarin@gmail.com.",
            "firstname": "Shiv Kumar",
            "initials": "SK",
            "lastname": "Sarin"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1007/s12072-020-10013-5",
    "journal": "Hepatology international",
    "keywords": [
        "AKI",
        "APASL score",
        "Acute kidney injury",
        "Door-to-scope time",
        "Hypoxic hepatitis",
        "Infections",
        "Lactate",
        "NAC",
        "Portal hypertension",
        "Shock"
    ],
    "methods": null,
    "publication_date": "2020-02-13",
    "pubmed_id": "32048131",
    "results": "Baseline characteristics were comparable. IH developed more frequently in Gr.B 25(23%) than A-15(14%); p\u2009=\u20090.08). Incidence of IH increased with severity of liver disease. Binary logistic regression analysis showed reduced incidence of IH in Gr.A than B [odds ratio (OR) 0.33, 0.11-0.93] patients after controlling for other significant factors. The incidence of acute kidney injury (AKI) was also reduced in Gr.A [OR 0.34, 0.15-0.75]. Development of IH was significantly associated with increased deaths due to liver failure at 6\u00a0weeks [subdistribution hazard ratio (SHR) 21.6, 7.4-62.8]. On multivariate competing risk analysis, significantly lower deaths due to liver failure (SHR 0.33, 0.11-0.97) were noted in Gr.A than B.",
    "title": "Utility of N-acetylcysteine in ischemic hepatitis in cirrhotics with acute variceal bleed: a randomized controlled trial.",
    "xml": "<Element 'PubmedArticle' at 0x788502379fd0>"
}