Predictive factors for liver and kidney injury in acetaminophen poisoning: A cross-sectional study

The aim of this study was to identify predictive factors for liver and kidney injury in patients with acetaminophen (APAP) poisoning.

This cross-sectional retrospective study was conducted on patients over 18 years of age admitted from January to December 2020 with APAP poisoning without prior liver or kidney issues.

Out of 2878 poisoned patients admitted, 146 patients with a mean age of 27.48 ± 8.92 years had APAP poisoning. Among them, 26.7% of patients experienced kidney injury, 15.1% had elevated aspartate aminotransferase (AST) and 6.11% had elevated alanine aminotransferase (ALT) both indicating hepatic injury. The amount of APAP consumed by the patient was identified as one of the best predictive factors for hepatic injury. Specifically, for every 1-g increase in APAP consumed by the patient, the odds of increased AST were 13% (odds ratio [OR] = 1.13 95% confidence interval [CI]: 1.002-1.27], P = 0.045), the odds of increased ALT were 15% (OR = 1.15 [95% CI: 0.99-1.22], P = 0.073), and the odds of an outcome with complications increased by 12% (OR = 1.12 [95% CI: 1.01-1.25], P = 0.031). The area under the curve (AUC) showed a significant relationship between the amount of APAP and the probability of hepatic injury (ALT) (AUC: 0.689; 95% CI: 0.520-0.858) (P = 0.028). The cut-off point for predicting an increase in ALT was determined to be 8.75 g of APAP, with a sensitivity of 55.6% and specificity of 71.4%.

The amount of APAP ingested is a clinical tool used to predict hepatic injury resulting from acute APAP overdose in adults. The recommended cut-off point of 8.75 g of APAP can help predict an increase in ALT levels.