Document Detail

A biochemical prognostic model of outcome in paracetamol-induced acute liver injury.
MedLine Citation:
PMID:  16378066     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The aim of this study was to develop a prognostic model of outcome for patients with paracetamol induced acute liver injury based on admission parameters METHODS: We used a cohort of 97 patients admitted to the Scottish Liver Transplant Unit between 1997 and 1998 to identify biochemical prognostic markers of outcome and thus create a prognostic model. Blood samples were taken on admission for analysis. The model was subsequently validated by testing it on a second cohort of 86 patients admitted between 1999 and 2000. RESULTS: The following were identified as independent variables of poor prognosis (death/ transplant); phenylalanine, pyruvate, alanine, acetate, calcium, haemoglobin and lactate. A prognostic model was then constructed by stepwise forward logistic regression analysis: (400xPyruvate mmols/L)+(50xPhenylalanine (mmols/L)-(4 x Hemoglobin (g/dL). A value of <16 had an accuracy of 93% in predicting death correctly. When applied to the validation cohort this model had a positive predictive value of 91%, a negative predictive value of 94%, a sensitivity of 91%, and a specificity of 94%. On the same population overall, the positive and negative predictive value of the King's criteria were 94% and 93% respectively, whereas their sensitivity and specificity were 88% and 96% respectively. CONCLUSIONS: Using admission characteristics our model is able to identify patients who die from paracetamol overdose fulminant hepatic failure as accurately as King's College criteria, but at a much earlier stage in their condition.
Konstantinos John Dabos; Philip Noel Newsome; John Andrew Parkinson; Janice Stewart Davidson; Ian Howard Sadler; John Nicholas Plevris; Peter Clive Hayes
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Transplantation     Volume:  80     ISSN:  0041-1337     ISO Abbreviation:  Transplantation     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-26     Completed Date:  2006-01-31     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1712-7     Citation Subset:  IM    
Department of Hepatology, Royal Infirmary of Edinburgh and Ultra High Field NMR Centre, Department of Chemistry, University of Edinburgh, Edinburgh, UK.
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MeSH Terms
Acetaminophen / toxicity*
Blood Chemical Analysis
Cohort Studies
Hemoglobins / analysis
Liver / drug effects,  pathology*
Liver Transplantation / pathology*,  physiology
Magnetic Resonance Spectroscopy
Methemoglobin / analogs & derivatives,  analysis
Neurotoxicity Syndromes / epidemiology
Reg. No./Substance:
0/Hemoglobins; 0/cyanomethemoglobin; 103-90-2/Acetaminophen; 9008-37-1/Methemoglobin

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