Acetaminophen use tied to negative outcomes in hepatitis-related ALF

Exposure to acetaminophen (paracetamol) may contribute to poor outcomes in patients with acute viral hepatitis (AVH)-related acute liver failure (ALF), suggests a study.

Of the 356 patients with AVH-ALF, 205 (57.5 percent) had evidence of acetaminophen use, while 87 (24 percent) had high or medium exposures. The aminotransferase and bilirubin levels of those with high or medium exposure resembled a mixed acetaminophen-viral injury.

The high-exposure group showed the highest mortality rate (51.6 percent) compared with the medium (21.4 percent), low (28.8 percent), and no exposure (30.5 percent) groups, as well as the lowest transplant-free survival (22.6 percent vs 44.6 percent, 41.5 percent, and 40.4 percent).

“However, the specific comparisons of mortality and transplant-free survival between the high exposure and no exposure groups were not statistically different even after adjusting for baseline patient characteristics differences,” the authors said.

This prospective, multicentre cohort study included patients who met the criteria for AVH, including hepatitis A, B, Epstein-Barr virus, and herpes simplex virus, all leading to ALF (hepatic encephalopathy after acute illness; international normalized ratio [INR] ≥1.5), or acute liver injury (acute liver injury; INR >2.0; no hepatic encephalopathy).

The authors then grouped eligible participants by acetaminophen exposure level: high, medium, low, or no exposure recorded.

“Prospective studies of the safest and effective dose of acetaminophen to use in patients with AVH are needed,” they said.