Browse > Article
http://dx.doi.org/10.22537/jksct.16.2.149

Usefulness of Predictors for Hepatotoxicity in Acetaminophen Poisoning Patient  

Kim, Eun Young (Department of Emergency Medicine, Yonsei University College of Medicine)
Chung, Sung Phil (Department of Emergency Medicine, Yonsei University College of Medicine)
Ko, Dong Ryul (Department of Emergency Medicine, Yonsei University College of Medicine)
Kong, Tae Young (Department of Emergency Medicine, Yonsei University College of Medicine)
You, Je Sung (Department of Emergency Medicine, Yonsei University College of Medicine)
Choa, Min Hong (Department of Emergency Medicine, Yonsei University College of Medicine)
Kim, Min Joung (Department of Emergency Medicine, Yonsei University College of Medicine)
Publication Information
Journal of The Korean Society of Clinical Toxicology / v.16, no.2, 2018 , pp. 149-156 More about this Journal
Abstract
Purpose: The purpose of this study was to determine whether hepatotoxicity could be predicted early using biochemical markers in patients with acetaminophen (AAP) poisoning and to assess the usefulness of predictive factors for acute liver injury or hepatotoxicity. Methods: This study was a retrospective observational study involving a medical records review. The participants were patients who were admitted to the emergency department (ED) with AAP overdose at two hospitals over a 10-year period. Demographic data, age, time from ingestion to visit, initial AAP level, initial hepatic aminotransferases, and initial prothrombin time were recorded. Acute liver injury was defined as a peak serum ALT >50 U/L or double the admission value, and hepatotoxicity was defined as a peak ALT >1,000 U/L. Receiver operating characteristic curve analyses were performed to compare the prognostic performance among variables. Results: A total of 97 patients were admitted to the ED with AAP overdose, of whom 26 had acute liver injury and 6 had hepatotoxicity. Acute liver injury was associated with the time interval after taking the drug, and hepatotoxicity was associated with the initial PT and the ALT level. The scoring system proposed by the authors has a significant ability to predict both acute liver injury and hepatotoxicity. Conclusion: To predict the prognosis of AAP poisoning patients, the time interval after taking AAP was important, and initial prothrombin time and ALT level were useful tests. Also a scoring system combining variables may be useful.
Keywords
Acetaminophen; Poisoning; Drug-induced acute liver injury;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Ostapowicz G, Fontana RJ, Schiodt FV, Larson A, Davern TJ, Han SH, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002;137:947-54.   DOI
2 Navarro VJ, Senior JR. Drug-Related Hepatotoxicity. New Engl J Med 2006;354:731-9.   DOI
3 Kessler B, Hoffman R. Treatment of paracetamol overdose. Lancet 2014;383:1382.
4 Prescott LF, Ballantyne A, Proudfoot AT, Park J, Adriaenssens P. Treatment of Paracetamol (Acetaminophen) Poisoning with N-acetylcysteine. Lancet 1977;310:432-4.   DOI
5 Yarema MC, Johnson DW, Berlin RJ, Sivilotti MLA, Nettel-Aguirre A, Brant RF, et al. Comparison of the 20-Hour Intravenous and 72-Hour Oral Acetylcysteine Protocols for the Treatment of Acute Acetaminophen Poisoning. Ann Emerg Med 2009;54:606-14.   DOI
6 Wong A, Graudins A. Risk prediction of hepatotoxicity in paracetamol poisoning. Clin Toxicol (Phila) 2017;55:879-92.   DOI
7 Green TJ, Sivilotti ML, Langmann C, Yarema M, Juurlink D, Burns MJ, et al. When do the aminotransferases rise after acute acetaminophen overdose? Clin Toxicol (Phila) 2010;48:787-92.   DOI
8 Levine M, O'Connor AD, Padilla-Jones A, Gerkin RD. Comparison of Prothrombin Time and Aspartate Aminotransferase in Predicting Hepatotoxicity After Acetaminophen Overdose. J Med Toxicol 2016;12:100-6.   DOI
9 Chomchai S, Chomchai C. Predicting acute acetaminophen hepatotoxicity with acetaminophen-aminotransferase multiplication product and the Psi parameter. Clin Toxicol (Phila) 2014;52:506-11.   DOI
10 Sivilotti ML, Green TJ, Langmann C, Yarema M, Juurlink D, Johnson D. Multiplying the serum aminotransferase by the acetaminophen concentration to predict toxicity following overdose. Clin Toxicol (Phila) 2010;48:793-9.   DOI
11 Payen C, Dachraoui A, Pulce C, Descotes J. Prothrombin time prolongation in paracetamol poisoning: a relevant marker of hepatic failure? Hum Exp Toxicol 2003;22:617-21.   DOI
12 Wong A, Sivilotti ML, Dargan PI, Wood DM, Greene SL. External validation of the paracetamol-aminotransferase multiplication product to predict hepatotoxicity from paracetamol overdose. Clin Toxicol (Phila) 2015;53:807-14.   DOI
13 Wong A, Sivilotti MLA, Graudins A. Accuracy of the paracetamol-aminotransferase multiplication product to predict hepatotoxicity in modified-release paracetamol overdose. Clin Toxicol (Phila) 2017;55:346-51.   DOI
14 Wong A, Sivilotti MLA, Gunja N, McNulty R, Graudins A. Accuracy of the paracetamol-aminotransferase product to predict hepatotoxicity in paracetamol overdose treated with a 2-bag acetylcysteine regimen. Clin Toxicol (Phila) 2018;56:182-8.   DOI
15 Cairney DG, Beckwith HK, Al-Hourani K, Eddleston M, Bateman DN, Dear JW. Plasma paracetamol concentration at hospital presentation has a dose-dependent relationship with liver injury despite prompt treatment with intravenous acetylcysteine. Clin Toxicol (Phila) 2016;54:405-10.   DOI
16 Rumack BH, Matthew H. Acetaminophen poisoning and toxicity. Pediatrics 1975;55:871-6.
17 Whyte IM, Buckley NA, Reith DM, Goodhew I, Seldon M, Dawson AH. Acetaminophen causes an increased International Normalized Ratio by reducing functional factor VII. Ther Drug Monit 2000;22:742-8.   DOI
18 Al-Hourani K, Mansi R, Pettie J, Dow M, Bateman DN, Dear JW. The predictive value of hospital admission serum alanine transaminase activity in patients treated for paracetamol overdose. QJM 2013;106:541-6.   DOI
19 Prescott LF, Roscoe P, Wright N, Brown SS. Plasma-paracetamol half-life and hepatic necrosis in patients with paracetamol overdosage. Lancet 1971;1:519-22.
20 Smilkstein MJ, Knapp GL, Kulig KW, Rumack BH. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985). N Engl J Med 1988;319:1557-62.   DOI
21 Daly FF, Fountain JS, Murray L, Graudins A, Buckley NA. Guidelines for the management of paracetamol poisoning in Australia and New Zealand--explanation and elaboration. A consensus statement from clinical toxicologists consulting to the Australasian poisons information centres. Med J Aust 2008;188:296-301.