Nazli Begum Ozturk, Ben L Da, Ghideon Ezaz, Thomas D Schiano
The majority of the patients with acetaminophen overdose survived to discharge. Most cases of acetaminophen overdose were intentional and were significantly associated with the presence of a psychiatric comorbidity. Intentional and unintentional overdoses had similar rates of ALF. Inpatient psychiatric hospitalization was frequently required, particularly for patients with intentional overdose.
BACKGROUND AND AIM: Acetaminophen toxicity is the most common cause of acute liver failure (ALF) in the United States. Among patients with acetaminophen toxicity, a vast majority have intentional overdose and concurrent psychiatric comorbidities. We aimed to analyze patient characteristics, patterns of overdose, and outcomes in patients with acetaminophen overdose at our liver transplantation (LT) center.
MATERIALS AND METHODS: Patients ≥18 years of age with acetaminophen overdose between 2011 and 2020 at our institution were identified. Patient demographics, clinical and laboratory data, patterns of overdose (intentional vs. unintentional), psychiatric comorbidities, need for admission to inpatient psychiatry service, transplant wait listing, need for transplantation, and death were assessed. Categorical variables are presented as counts with percentages, continuous variables as median with interquartile range IQR (Q1-Q3), and p<0.05 was considered significant.
RESULTS: A total of 165 (118 female, 47 male) patients were admitted with acetaminophen toxicity. Seventy-one (43.0%) patients met criteria for ALF. The median age was 32 years (IQR 25-49), and 112 (67.9%) patients had concurrent psychiatric comorbidities. Ninety-six (58.2%) patients had intentional overdose, while 69 (41.8%) patients had unintentional overdose. Twenty-three (13.9%) patients were listed for LT, and seven (4.2%) patients underwent LT. Eighty-one (49.1%) patients were subsequently admitted to the inpatient psychiatry service. Eleven (6.7%) patients died, five of whom were on the LT list. There was no significant difference in LT listing between patients with and without psychiatric comorbidities.
CONCLUSION: The majority of the patients with acetaminophen overdose survived to discharge. Most cases of acetaminophen overdose were intentional and were significantly associated with the presence of a psychiatric comorbidity. Intentional and unintentional overdoses had similar rates of ALF. Inpatient psychiatric hospitalization was frequently required, particularly for patients with intentional overdose.