An Analysis of Patients with Acetaminophen Overdose: Liver Injury, Patterns of Overdose, and Liver Transplantation
Document Type
Conference Proceeding
Publication Date
5-2024
Publication Title
Gastroenterology
Abstract
Introduction: Acetaminophen overdose is the most common cause of acute liver failure (ALF) in the United States. Among patients with acetaminophen overdose, intentional overdose constitutes the majority of the cases. Despite having a favorable prognosis compared to other causes of ALF, prompt identification, medical treatment, and transfer to a liver transplantation (LT) center are essential for optimal outcomes. We aimed to analyze patient characteristics, overdose patterns, and outcomes in patients with acetaminophen overdose. Methods: Patients older than 18 years of age with acetaminophen overdose between 2011- 2020 at our institution were identified. Patients with known liver disease were excluded. Patient demographics, liver injury, overdose patterns, psychiatric comorbidities, and outcomes were analyzed. Data is presented as numbers with percentages or median with interquartile range (Q1-Q3), and p< 0.05 was considered significant. Results: A total of 165 (118 female, 47 male) patients were included in the analysis. Seventyone (43.03%) patients had ALF, and 15 (9.09%) patients had acute liver injury. One hundred and three (62.42%) patients had severe hepatotoxicity (ALT >10 times the upper limit of normal and INR >1.5). The median age was 32 (25-49) years. Among all, 112 (67.87%) patients had concurrent psychiatric comorbidities. Ninety-six (58.18%) patients had intentional overdose. Co-ingestion with alcohol was present in 27 (16.36%) patients. All patients received N-acetylcysteine (NAC), administered for a median duration of 48 (24-72) hours. Twenty-three (13.93%) patients were listed for LT, and seven (4.24%) patients underwent LT within a median of three (1-6) days. Eighty-one (49.09%) patients were admitted to inpatient psychiatry service. A total of 11 (6.66%) patients died, five of whom were on the LT list, and six patients were not candidates for LT. Patients with intentional overdose were younger (p< 0.005), had more inpatient psychiatry admissions ( p< 0.0005), and had longer length of stay (p< 0.05) compared to patients with unintentional overdose. Patients with psychiatric comorbidities had significantly more intentional overdoses ( p=0.0002), more inpatient psychiatric hospitalizations (p=0.0001), and were listed for LT more often ( p= 0.0075) compared to patients without psychiatric comorbidies. Discussion: The majority of the patients with acetaminophen overdose survived and recovered without lasting complications. The overall transplant rate was 4.24%, and death rate was 6.66%. Most cases of acetaminophen overdose were intentional and was associated significantly with the presence of a psychiatric comorbidity. Both patients with intentional and unintentional acetaminophen overdose had similar rates of ALF. The presence of ALF was the most important factor affecting length of stay and overall survival.
Volume
166
Issue
5 Suppl
First Page
S1619
Recommended Citation
Ozturk NB, Da BL, Ezaz GZ, Schiano T. An analysis of patients with acetaminophen overdose: liver injury, patterns of overdose, and liver transplantation. Gastroenterology. 2024 May;166(5 Suppl):S1619. doi: 10.1016/S0016-5085(24)04183-0
DOI
10.1016/S0016-5085(24)04183-0
Comments
DDW Digestive Disease Week, May 18-21, 2024, Washington, DC