Therapeutic Impact of N-Acetylcysteine on Liver Damage Caused by HELLP Syndrome in Pregnant Women

Background N-acetylcysteine (NAC) has garnered attention in recent years for its potential therapeutic benefits in treating various conditions, particularly those associated with oxidative stress. Among its many applications, NAC may offer significant therapeutic advantages in addressing liver damage linked to HELLP syndrome, a serious pregnancy-related complication. HELLP syndrome, characterized by hemolysis, elevated liver enzymes, and low platelet counts, can lead to severe maternal and fetal morbidity if not recognized and treated promptly. Given the complexity of HELLP syndrome and its implications for liver function, exploring NAC's role as a protective agent is of paramount importance. Objectives The primary aim of this study is to thoroughly evaluate the therapeutic effects of NAC on postoperative liver toxicity specifically in pregnant women diagnosed with HELLP syndrome. By investigating the biochemical markers of liver function pre- and post-treatment with NAC, this research seeks to elucidate the potential benefits of NAC in mitigating liver damage and optimizing maternal health outcomes during and after pregnancy. Methods A comprehensive retrospective review was conducted on the medical records of 120 pregnant women diagnosed with HELLP syndrome from 2015 to 2019. Participants were stratified into two distinct groups: one receiving NAC and the other serving as a control and not receiving NAC. The treatment protocol stipulated that when alanine aminotransferase (ALT) or gamma-glutamyl transferase (GGT) levels exhibited an increase to four times the normal threshold, 60 patients were administered NAC at a dosage of 50 mg/kg intravenously, divided into three doses administered over a 24-hour period for a duration of five consecutive days. The control group comprised 60 postoperative patients diagnosed with HELLP syndrome who did not receive NAC treatment. ALT and GGT levels were meticulously assessed at several time points: prior to treatment initiation, immediately following treatment completion, and on days 1, 3, 5, and 10 post-treatment, thereby providing a comprehensive overview of liver function recovery over time. Results Significant differences in ALT and GGT levels were observed on days 1, 3, 5, and 10 post-treatment, with a marked decline noted from day 1 to day 7 in the NAC group. A statistically significant difference (p< 0.001) was identified, underscoring the efficacy of NAC in promoting liver function recovery. Interestingly, the non-NAC group also demonstrated a decrease in ALT levels on day 10 compared to day 1, albeit at a slower rate. When comparing ALT and GGT levels between the NAC and non-NAC groups, the NAC group exhibited a more rapid decline in these values, indicating a favorable response to the NAC treatment regimen. Conclusions The findings of this study strongly suggest that administration of NAC has the potential to protect the liver in pregnant women affected by HELLP syndrome, leading to a significant reduction in hepatotoxicity associated with this condition. These results, as indicated by the early and substantial improvements in liver function tests, highlight the importance of timely intervention with NAC in managing the complications of HELLP syndrome.