Mono-Center Study: Acetaminophen-Induced Liver Injury is the most Common Cause of Acute Liver Failure

Abstract

Aims: Acetaminophen-Induced hepatotoxcity is likely the most important cause of acute liver failure (ALF) in the western countries. To date however, no data exists on the relevance of paracetamol intoxication in Germany. AIM: To determine the incidence and risk factors of acetaminophen-induced hepatotoxcity and ALF in our center over a four-year period. Methods: A retrospective mono-center four-year study (2002–2005) enrolled 20 patients [15 females (75%) / five males (25%), at a median of 31±12 years of age] with paracetamol poisoning transferred to our transplant center; only 18 of these fulfilled established ALF criteria. All patient histories were thoroughly reviewed. Throughout the course of the study, patients were monitored for established clinical signs and laboratory parameters of acute liver injury. Results: The median acetaminophen overdose was 21.5±5 grams, at 65% of the cases with a suicidal intention. Of the 20 patients, 18 (90%) developed ALF. Fourteen of those 18 patients (72%) showed clear signs of spontaneous recovery, and all survived without being listed for liver transplantation (LTx). Of the remaining four patients, three (15%) died while waiting for a graft, and one underwent LTx. Remarkably, six (33%) of 18 patients were diagnosed with steatosis. As expected, AST (1.646±623) was found more elevated than ALT (1371±534); the main bilirubin value was 10.9±5.6mg/dl, INR 1.45±2.3, and creatinine 1.22±0.7, respectively. Conclusions: These data confirm that acetaminophen-induced hepatotoxicity likewise is the most common single cause of ALF in this center (mostly due to suicidal intention). Fatty liver appears to predispose for ALF. The majority of cases spontaneously recovered through intensive-care treatment without necessitating LTx. Our findings caution towards a greater awareness re. prescribing paracetamol, as well as to a closer monitoring of patients at risk of developing liver failure.