Predicting mortality from acetaminophen poisoning shortly after hospital presentation
| Autor: | Chris DeWitt, Marco L.A. Sivilotti, Elizabeth Haney, Margaret Thompson, David W. Johnson, Charlemagne Victorino, Sophie Gosselin, Jason A Lord, Barry H. Rumack, Benoit Bailey, Daniel A. Spyker, Roy Purssell, Nancy G. Murphy, Kathryn Dong, Alberto Nettel-Aguirre, Mark Yarema |
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| Rok vydání: | 2021 |
| Předmět: |
Canada
medicine.medical_specialty Encephalopathy Poison control Severity of Illness Index 030226 pharmacology & pharmacy End Stage Liver Disease 03 medical and health sciences 0302 clinical medicine Model for End-Stage Liver Disease Internal medicine Coagulopathy Humans Medicine Ingestion Pharmacology (medical) Hospital Mortality 030212 general & internal medicine Acetaminophen Retrospective Studies Pharmacology business.industry Acetaminophen poisoning digestive oral and skin physiology Analgesics Non-Narcotic medicine.disease Hospitals Serum lactate Chemical and Drug Induced Liver Injury Drug Overdose business medicine.drug |
| Zdroj: | British Journal of Clinical Pharmacology. 87:3332-3343 |
| ISSN: | 1365-2125 0306-5251 |
| Popis: | Aims Early identification of patients likely to die after acetaminophen (APAP) poisoning remains challenging. We sought to compare the sensitivity and time to fulfilment (latency) of established prognostic criteria. Methods Three physician toxicologists independently classified every in-hospital death associated with APAP overdose from eight large Canadian cities over three decades using the Relative Contribution to Fatality scale from the American Association of Poison Control Centres. The sensitivity and latency were calculated for each of the following criteria: King's College Hospital (KCH), Model for End Stage Liver Disease (MELD) ≥33, lactate ≥3.5 mmol/L, phosphate ≥1.2 mmol/L 48+ hours post-ingestion, as well as combinations thereof. Results A total of 162 in-hospital deaths were classified with respect to APAP as follows: 26 Undoubtedly, 40 Probably, 27 Contributory, 14 Probably not, 25 Clearly not, and 30 Unknown. Cases from the first three classes (combined into n = 93 "APAP deaths") typically presented with supratherapeutic APAP concentrations, hepatotoxicity, acidaemia, coagulopathy and/or encephalopathy, and began antidotal treatment a median of 12 hours (IQR 3.4-30 h) from the end of ingestion. Among all patients deemed "APAP deaths", meeting either KCH or lactate criteria demonstrated the highest sensitivity (94%; 95% CI 86-98%), and the shortest latency from hospital arrival to criterion fulfilment (median 4.2 h; IQR 1.0-16 h). In comparison, the MELD criterion demonstrated a substantially lower sensitivity (55%; 43-66%) and longer latency (52 h; 4.4-∞ h, where "∞" denotes death prior to criterion becoming positive). Conclusions Meeting either KCH or serum lactate criteria identifies most patients who die from acetaminophen poisoning at or shortly after hospital presentation. |
| Databáze: | OpenAIRE |
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