Abstract
BackgroundAcetaminophen overdose (AO) is the most common cause of acute liver failure. We examined temporal trends and sociodemographic risk factors for AO in a large Canadian health region.Methods1,543 patients hospitalized for AO in the Calgary Health Region (population ~1.1 million) between 1995 and 2004 were identified using administrative data.ResultsThe age/sex-adjusted hospitalization rate decreased by 41% from 19.6 per 100,000 population in 1995 to 12.1 per 100,000 in 2004 (P < 0.0005). This decline was greater in females than males (46% vs. 29%). Whereas rates fell 46% in individuals under 50 years, a 50% increase was seen in those ≥ 50 years. Hospitalization rates for intentional overdoses fell from 16.6 per 100,000 in 1995 to 8.6 per 100,000 in 2004 (2004 vs. 1995: rate ratio [RR] 0.49; P < 0.0005). Accidental overdoses decreased between 1995 and 2002, but increased to above baseline levels by 2004 (2004 vs. 1995: RR 1.24;P < 0.0005). Risk factors for AO included female sex (RR 2.19; P < 0.0005), Aboriginal status (RR 4.04; P < 0.0005), and receipt of social assistance (RR 5.15; P < 0.0005).ConclusionHospitalization rates for AO, particularly intentional ingestions, have fallen in our Canadian health region between 1995 and 2004. Young patients, especially females, Aboriginals, and recipients of social assistance, are at highest risk.
Highlights
Acetaminophen overdose (AO) is the most common cause of acute liver failure
Study population The study population consisted of hospitalized patients with acetaminophen overdose residing in the Calgary Health Region (CHR) between fiscal years 1995 to 2004
Cases of acetaminophen overdose were identified via a search of the 16 diagnosis coding fields for diagnostic code 965.4 according to the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) [18] in the 1995– 2001 discharge data, and T39.1 according to ICD-10 [19] in the 2002–2004 discharge data
Summary
Acetaminophen overdose (AO) is the most common cause of acute liver failure. Acetaminophen is the most commonly implicated drug in cases of acute liver failure (ALF) predominantly due to its widespread availability [1,2,3,4,5]. Recent data from the US ALF Study Group identified acetaminophen as the etiology in approximately 50% of cases[2,3]. Acetaminophen overdose typically has a good prognosis, even if hepatic failure has developed. Less than 5% of patients who take toxic quantities of acetaminophen (approximately 150 mg/kg body weight) develop acute liver toxicity [7]. Survival without transplantation for those who develop encephalopathy (~65%) exceeds that for most other forms of ALF [2,3,4]. Nearly one-third of those developing encephalopathy will die and 8% require transplantation (page number not for citation purposes)
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