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Macrophage Migration Inhibitory Factor as a Potential Biomarker in Acetaminophen Overdose: A Pilot Study
Joshua Bloom1, Teddy Uzamere2, Yasmin Hurd2
1Department of Emergency Medicine, Mount Sinai West, New York, NY.
Introduction:
Acetaminophen overdose is a leading cause of liver failure in the United States. Macrophage migration inhibitory factor (MIF) is a cytokine that is released early and promotes acetaminophen toxicity in preclinical models. This cytokine could prove a useful biomarker in emergency department (ED) patients immediately following an acute acetaminophen overdose.
Methods:
We selected a convenience sample of thirteen patients from a prospective consecutive cohort of ED patients with suspected acute overdose. Research associates collected waste specimens for MIF analysis that remained after use for clinical care. Our team compared patients with confirmed acetaminophen overdose (n=9) to patients without acetaminophen exposure or liver injury (n=3) and a patient with liver injury in the absence of detectable acetaminophen (n=1).
Results:
In our acetaminophen group, all nine patients had measurable acetaminophen concentrations. Median MIF serum concentrations were 16.08 ng/mL (IQR 2.06, 91.40) in the overdose group compared with the control group serum concentrations of 0.19 ng/mL (IQR 0.05, 0.32) (p = 0.0091).
Conclusion:
In this pilot study, MIF was feasible to measure in specimens from an ED drug overdose cohort, and was significantly elevated in the acetaminophen group compared to non-acetaminophen controls without liver injury.
Insights
Macrophage migration inhibitory factor (MIF) shows promise as a biomarker for acetaminophen overdose. Elevated MIF levels were observed in emergency department patients with confirmed acetaminophen overdose, suggesting its utility in early detection.
Area of Science:
- Toxicology
- Biochemistry
- Emergency Medicine
Background:
- Acetaminophen overdose is a primary cause of acute liver failure in the U.S.
- Macrophage migration inhibitory factor (MIF), a cytokine, exacerbates acetaminophen-induced toxicity in preclinical studies.
- MIF's potential as an early biomarker in emergency department (ED) settings for acute acetaminophen overdose warrants investigation.
Purpose of the Study:
- To assess the feasibility of measuring MIF in ED patients with suspected acute acetaminophen overdose.
- To determine if MIF serum concentrations are elevated in patients with confirmed acetaminophen overdose compared to controls.
- To explore MIF's potential as a diagnostic biomarker for acetaminophen toxicity.
Main Methods:
- A convenience sample of 13 ED patients with suspected acute overdose was enrolled.
- Waste specimens were collected for MIF analysis.
- Patients were categorized into confirmed acetaminophen overdose (n=9), no acetaminophen exposure/liver injury (n=3), and liver injury without acetaminophen (n=1).
Main Results:
- All nine patients in the acetaminophen group had detectable acetaminophen levels.
- Median MIF serum concentration was significantly higher in the acetaminophen overdose group (16.08 ng/mL) compared to the control group (0.19 ng/mL) (p=0.0091).
- MIF measurement was feasible in ED drug overdose specimens.
Conclusions:
- MIF can be feasibly measured in specimens from emergency department drug overdose patients.
- Serum MIF levels were significantly elevated in patients with acetaminophen overdose.
- MIF demonstrates potential as a valuable biomarker for early detection of acetaminophen overdose in the ED.
