American Board of Internal Medicine (ABIM) Certification Practice Exam

What has N-acetylcysteine been shown to improve in cases of non-acetaminophen-related acute liver failure?

1. Overall liver function

2. Transplant-free survival

3. Decreased bilirubin levels

4. Quality of life

The correct answer is: Transplant-free survival

N-acetylcysteine (NAC) has been extensively studied for its role in treating acute liver failure, particularly for its impact on transplant-free survival in cases that are non-acetaminophen-related. Evidence supports that NAC acts as a potent antioxidant, helps restore glutathione levels, and encourages the detoxification of harmful substances, which collectively contribute to improved outcomes in liver failure scenarios. In the context of non-acetaminophen acute liver failure, studies indicate that patients who receive NAC may demonstrate a higher rate of survival without the need for liver transplantation when compared to those who do not receive the treatment. This can be particularly significant in cases where alternative therapeutic options are limited, underscoring NAC’s value in promoting better survival outcomes in these complex medical situations. While NAC may also have effects on other parameters like overall liver function or quality of life, its primary and most compelling evidence relates directly to enhancing transplant-free survival, making that the most appropriate and relevant choice in this scenario.