title: Outcomes of patients with acetaminophen-associated toxic hepatitis at a far east poison center.
abstract: BACKGROUND
  There is an overall paucity of data regarding the outcomes of patients with acetaminophen-associated toxic hepatitis in Taiwan. Therefore, the purpose of this study was to recruit a larger number of patients and to examine the clinical features, the degrees of toxic hepatitis, the physiological markers, and the clinical outcomes after intentional acetaminophen poisoning, and to determine what association, if any, might exist between these findings.
  
  
  METHODS
  We examined the medical records of 187 patients with intentional acetaminophen poisoning who were examined at Chang Gung Memorial Hospital between 2000 and 2011. Patients were categorized into 2 groups according to hepatic complications, i.e. with (n = 15) or without (n = 172) toxic hepatitis. Demographic, clinical, and laboratory data were collected, and the mortality rate was analyzed.
  
  
  RESULTS
  It was found that patients with toxic hepatitis had higher serum acetaminophen level (P = 0.007), but they also arrived to the hospital later (P < 0.001) than patients without toxic hepatitis. Furthermore, patients with toxic hepatitis showed higher incidences of acute respiratory failure (P = 0.012) than those shown by patients who did not have hepatitis. The laboratory examinations also revealed greater degrees of granulocytosis (P < 0.001) and poorer liver function tests (P < 0.001) in patients with hepatitis than in patients without hepatitis. Nevertheless, a univariate logistic regression model failed to identify any significant risk factors for toxic hepatitis complication after ingestion (P > 0.05). At the end of the analysis, 1 patient with toxic hepatitis died of liver failure. Finally, there was no significant difference in mortality between patients with and without hepatitis (P = 0.080).
  
  
  CONCLUSIONS
  The analytical data revealed that toxic hepatitis was not uncommon (15/187 or 8.0%) after acetaminophen overdose. Further studies are warranted.
authors.affiliation: Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan.
authors.forename: Yi-Chou
authors.initials: YC
authors.lastname: Hou
authors.affiliation: Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan.
authors.forename: Ja-Liang
authors.initials: JL
authors.lastname: Lin
authors.affiliation: Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan.
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Huang
authors.affiliation: Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan.
authors.forename: Cheng-Hao
authors.initials: CH
authors.lastname: Weng
authors.affiliation: Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan.
authors.forename: Shen-Yang
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan.
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Hsu
authors.affiliation: Department of Nephrology, China Medical University Hospital and China Medical University, Taichung, Taiwan.
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.affiliation: Department of Nephrology, China Medical University Hospital and China Medical University, Taichung, Taiwan.
authors.forename: Chih-Chia
authors.initials: CC
authors.lastname: Liang
authors.affiliation: Department of Nephrology, China Medical University Hospital and China Medical University, Taichung, Taiwan.
authors.forename: Chiz-Tzung
authors.initials: CT
authors.lastname: Chang
authors.affiliation: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan.
authors.forename: Wey-Ran
authors.initials: WR
authors.lastname: Lin
authors.affiliation: Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan ; Department of Nephrology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, 105 Taiwan.
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
keywords: Acetaminophen; N-acetylcysteine; Poisoning; Suicide; Toxic hepatitis