title: A biochemical prognostic model of outcome in paracetamol-induced acute liver injury.
abstract: 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.
authors.affiliation: Department of Hepatology, Royal Infirmary of Edinburgh and Ultra High Field NMR Centre, Department of Chemistry, University of Edinburgh, Edinburgh, UK. kostasophia@yahoo.com
authors.forename: Konstantinos John
authors.initials: KJ
authors.lastname: Dabos
authors.forename: Philip Noel
authors.initials: PN
authors.lastname: Newsome
authors.forename: John Andrew
authors.initials: JA
authors.lastname: Parkinson
authors.forename: Janice Stewart
authors.initials: JS
authors.lastname: Davidson
authors.forename: Ian Howard
authors.initials: IH
authors.lastname: Sadler
authors.forename: John Nicholas
authors.initials: JN
authors.lastname: Plevris
authors.forename: Peter Clive
authors.initials: PC
authors.lastname: Hayes
mesh_terms: D000082:Acetaminophen / Q000633:toxicity*; D000328:Adult; D001774:Blood Chemical Analysis; D015331:Cohort Studies; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000473:pathology*; D016031:Liver Transplantation / Q000473:pathology* / Q000502:physiology; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008706:Methemoglobin / Q000031:analogs & derivatives / Q000032:analysis; D020258:Neurotoxicity Syndromes / Q000453:epidemiology; D011379:Prognosis
chemical_list: D006454:Hemoglobins; C007169:cyanomethemoglobin; D000082:Acetaminophen; D008706:Methemoglobin