N-Acetyl Cysteine With Steroid Versus Steroid Alone In Severe Alcoholic Hepatitis: A Systematic Review And Meta-Analysis

Introduction: Increased oxidative stress plays a major role in hepatocyte damage in alcoholic hepatitis.N-acetyl cysteine is an antioxidant that replenishes glutathione stores and counteracts the oxidative stress.Various studies have assessed the role of antioxidants alone or compared to steroids in alcoholic hepatitis but there has been no prior meta-analysis comparing the benefits of N-acetyl cysteine with steroid compared to steroids alone hence, we decided to conduct this meta-analysis in this novel topic.Methods: Online databases like Pubmed, PubMed Central, Embase and Scopus were accessed and searched for relevant studies published till December 1, 2020.We screened the studies using Covidence and performed the analysis using RevMan 5.4.Odds Ratio (OR) was used for outcome estimation with 95% Confidence Interval (CI).Assessment of heterogeneity was done using the Isquared (I2) test.We used a random-effect model for the pooling of selected studies.Results: Among a total of 2030 studies, only 3 studies meeting inclusion criteria were selected for qualitative analysis.Use of NAC with steroid did not make any significant differences in mortality at 30 days (OR 0.72, 95% CI 0.20 to 2.62) and in 3 months (OR 1.16, 95% CI 0.21 to 6.36).Overall infection rate between the two groups also did not reach the statistical significance (OR 0.51, 95% CI 0.19 to 1.40).Similarly, the odds of Lille score < 0. 45 among the two groups did not show statistically significant differences (OR 1.81, 95% CI 0.36 to 9. 19). Conclusion:There was no survival benefit with N-acetyl cysteine and steroids compared to steroid alone in severe alcoholic hepatitis.Although the reduction in the overall risk of infections and favourable Day 7 Lille scores were achieved with the combination, the finding was not statistically significant urging larger studies to reach a firm conclusion.