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Systematic review and meta-analysis of the effect of N-acetylcysteine on outcomes after liver resection.

  • 2024-08-05
  • ANZ journal of surgery 94(10)
    • Amanda Koh
    • Tiffany Wong
    • Alfred Adiamah
    • Sudip Sanyal

Study Design

Type
Meta-Analysis
Sample size
n = 388
Population
388 patients undergoing hepatectomy
Methods
Comprehensive search of MEDLINE, EMBASE, and Cochrane databases for RCTs; random-effects model; protocol registered on PROSPERO

Background

N-Acetylcysteine (NAC) is a recognized antioxidative agent that facilitates the conjugation of toxic metabolites. In recent years, NAC has been routinely used to limit ischaemia-reperfusion injury in liver transplantation. There remains, however, contradictory evidence on its effectiveness in liver resection. This meta-analysis examines the effectiveness of NAC in improving outcomes following hepatectomy.

Methods

A comprehensive search of the MEDLINE, EMBASE, and Cochrane databases was performed to identify relevant randomized controlled trials (RCTs) published since database inception until November 2023. The outcomes of Day 1 biochemical markers (lactate, ALT, bilirubin, and INR), length of stay, transfusion rates, and morbidity were extracted. Quantitative pooling of data was based on a random-effects model. The study protocol was registered on PROSPERO (Registration no: CRD42023442429).

Results

Five RCTs reporting on 388 patients undergoing hepatectomy were included in the analysis. There were no significant differences in patient demographics between groups. Post-operative lactate was lower in patients receiving NAC (WMD -0.61, 95% CI -1.19 to -0.04, I2 = 67%). There were, however, no differences in the post-operative INR (WMD -0.04, 95% CI -0.19 to 0.12, I2 = 96%) and ALT (WMD -94.94, 95% CI -228.46 to 40.38; I2 = 67%). More importantly, there were no statistically significant differences in length of stay, transfusion rates, and morbidity between the two groups.

Conclusion

The administration of NAC in liver resection did not alter important biochemical parameters suggesting any real effectiveness in reducing hepatic dysfunction. There were no improvements in the clinical outcomes of length of stay, transfusion rates, and overall morbidity.

Research Insights

  • N-Acetyl Cysteine→Reduced ALT Level

    and ALT (WMD -94.94, 95% CI -228.46 to 40.38; I² = 67%).

    Effect
    Neutral
    Effect size
    Small
  • N-Acetyl Cysteine→Reduced INR

    There were, however, no differences in the post-operative INR (WMD -0.04, 95% CI -0.19 to 0.12, I² = 96%)

    Effect
    Neutral
    Effect size
    Small
  • N-Acetyl Cysteine→Reduced Lactate Level

    Post-operative lactate was lower in patients receiving NAC (WMD -0.61, 95% CI -1.19 to -0.04, I² = 67%).

    Effect
    Beneficial
    Effect size
    Small
  • N-Acetyl Cysteine→Reduced Length of Stay

    More importantly, there were no statistically significant differences in length of stay, transfusion rates, and morbidity between the two groups.

    Effect
    Neutral
    Effect size
    Small
  • N-Acetyl Cysteine→Reduced Morbidity

    More importantly, there were no statistically significant differences in length of stay, transfusion rates, and morbidity between the two groups.

    Effect
    Neutral
    Effect size
    Small
  • N-Acetyl Cysteine→Reduced Transfusion Rate

    More importantly, there were no statistically significant differences in length of stay, transfusion rates, and morbidity between the two groups.

    Effect
    Neutral
    Effect size
    Small

Adverse Events Reported

  • N-Acetyl Cysteine→Overall tolerability

    there were no statistically significant differences in length of stay, transfusion rates, and morbidity between the two groups

    Finding
    No significant difference
    Significant
    No
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