Predicting acute acetaminophen hepatotoxicity with acetaminophen-aminotransferase multiplication product and the Psi parameter

Abstract

Psi and APAP × AT are valid clinical tools in predicting hepatotoxicity secondary to acute acetaminophen overdose in adults. APAP × AT is useful in predicting a low likelihood of hepatotoxicity after standard NAC therapy among late-presenting patients.

Being overweight or obese as a risk factor for acute liver injury secondary to acute acetaminophen overdose

“…A retrospective cohort by Radosevich in 2016 finds that obese patients (BMI > 30) has reduced incidence of hepatotoxicity (27.5%), as compared to the 37.5% from nonobese cases (BMI 18.5‐24.9). However, it is still important to note that these reported incidences are clearly higher than the 7.3% to 15.8% traditionally found in the general populations . In an animal model of obesity using overfed Spraque‐Dawley rats, the obese rats demonstrated increased acetaminophen hepatotoxicity compared with controls…”

“…This is a retrospective cohort study based on a secondary data analysis of the Siriraj Acute Acetaminophen Hepatotoxicity Project . The protocol was approved by Siriraj Hospital Ethic Committee, which received accreditation from the Association for the Accreditation of Human Research Protection Program (AAHRPP).…”

“…Patient outcomes were classified into 1 of 3 categories according to their highest aspartate aminotransferase (AST) or alanine aminotransferase (ALT). They were defined as having hepatotoxicity if AST or ALT reached 1000 U/L or above, and having ALI if the AST or ALT had doubled that of the initial value to at least 150 U/L, or normal if no significant changes in AST and ALT occurred throughout the follow‐up period. Psi parameter, a composite mathematic parameter of timed acetaminophen concentration and onset of NAC therapy, was calculated for each patient.…”

“…Psi parameter, a composite mathematic parameter of timed acetaminophen concentration and onset of NAC therapy, was calculated for each patient. High‐ and low‐psi groups were defined as psi parameters of more than or equal to 5 mM‐hour and less than 5 mM‐hour, respectively …”

“…Psi parameter, which quantifies the risk of hepatotoxicity by using the pre‐NAC acetaminophen concentration and time to NAC therapy, is a known independent predictor of hepatotoxicity due to acute acetaminophen overdose . A larger psi value resulting from higher acetaminophen concentration and more delayed NAC onset is associated with increased incidence of hepatotoxicity . In addition, some intrinsic characteristics of the patients themselves may also play a significant role in determining the toxic potential of an overdose.…”