Source: DGNews  |  Posted 2 years ago

By Cheryl Lathrop

BOSTON -- November 2, 2009 -- While alcohol use is common in
acetaminophen-related acute liver failure (ALF), it does not appear to increase
acetaminophen-related mortality or the need for liver transplantation,
according to research presented here at the Liver Meeting 2009, the 60th Annual
Meeting of the American Association for the Study of Liver Diseases (AASLD).

Alcohol users, however, have lower acetaminophen levels, higher aspartate
aminotransferase (AST), renal insufficiency, and higher Model for End-Stage
Liver Disease (MELD) scores than nonusers, noted Lulu Iles-Shih, MD, Oregon
Health and Sciences University, Portland, Oregon, speaking here at a poster
session on October 31.

Acetaminophen is the most common cause of ALF in the United States. Although
alcohol can potentiate hepatotoxicity, its impact on the outcome of
acetaminophen-related ALF was unknown. The aim of this study was to assess the
association between alcohol use and adverse outcomes. The hypothesis was that
individuals who consume alcohol do indeed have worse outcomes than those that
do not. The authors, however, decided that alcohol does not appear to increase
acetaminophen-related mortality or the need for liver transplantation.

Dr. Iles-Shih and colleagues examined 622 subjects (74% female) with
acetaminophen-related ALF who had enrolled in the prospective US Acute Liver
Failure Study (January 1998 to November 2008). Binary logistic regression was
used to characterise the effect of alcohol on rates of death or liver
transplantation (after controlling for confounders).

Data regarding alcohol use were available for 99% of patients: 51.2% (n = 315)
consumed alcohol. The amount of alcohol was quantified in 56% of this group of
consumers -- the median alcohol consumed was 40 g/day; the mean alcohol
consumed was 69.4 g/day (range 10 to 1,000 g). It was noted that females were
less likely to drink alcohol; there were 67.7% females in the alcohol group and
82.7% females in the non-alcohol group.

Death occurred in 25.2% (n = 157) of subjects, and 8.4% (n = 52) had a liver
transplant.

Alcohol users had a higher admission creatinine (2.68 mg/dL [standard error
{SE} +- 0.1] vs 2.34 mg/dL [SE +- 0.13]), higher AST (6,701 IU/L +- 428 vs
4,696 IU/L +- 258), higher MELD scores (32.3 vs 29.7), and lower acetaminophen
levels (52.4 mg/L +- 4.01 vs 76.7 +- 6.75) than non-alcohol users.

No differences were observed in age, race, international normalised ratio upon
admission, body mass index, mean arterial pressure, or mode of toxicity
(intentional or unintentional).

Presentation title: Role of Alcohol in Acetaminophen-Related Acute Liver
Failure. Abstract 272