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LOS ANGELES (May 21, 2006) Acetaminophen as a Co-Factor in Acute Liver Failure Due to Viral Hepatitis Determined by Measurement of Acetaminophen-Protein Adducts [Abstract S1002]
Acetaminophen (APAP) is a common over-the-counter medication present in more than 300 preparations for pain relief and flu-like symptoms. But for people who are suffering from viral hepatitis A or B, use of acetaminophen may play a role in accelerating liver failure, ordinarily a rare complication of viral hepatitis.
Serum samples from 72 patients with proven hepatitis A or B that had progressed to liver failure were tested for APAP adducts, which are the toxic byproducts of acetaminophen liver damage, created when a chemical (in this case, acetaminophen) binds to proteins in the liver that are then released into the blood when cells die. As a positive control group, the team also included 10 documented cases of acute liver failure (ALF) resulting directly from large APAP overdoses.
Results from the examination showed that nine of the 72 patients (12.5 percent) had detectable APAP adducts in their blood, signifying that some of their liver damage was APAP-related. All 10 known APAP-induced ALF cases had positive adducts at much higher levels than those in the viral hepatitis group (average level of 5.58 nmol/mL versus 0.45 nmol/mL, respectively). Two-thirds (67 percent) of the hepatitis patients with APAP adducts died within three weeks of study admission, compared to only 27 percent of hepatitis patients without adducts.
Most of the patients with adducts reported some APAP use in the days prior to the study, but none reported doses exceeding four grams per day. Flu-like symptoms, nausea and vomiting are common in patients with early viral hepatitis and APAP is commonly used in this setting.
“This study suggests that acetaminophen, even when taken at therapeutic dosages, is responsible for a second hit in viral hepatitis and explains why some patients develop acute liver failure and death in this setting,” said William M. Lee, M.D., of the UT Southwestern Medical Center in Texas, and senior study author. “Warnings regarding use of acetaminophen should be clearly communicated to patients with acute viral hepatitis, particularly those of moderate severity, to reduce these bad outcomes from a relatively benign disease.”
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Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 20-25, 2006 in Los Angeles, California. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.
Reprinted with permission of Digestive Disease Week® 2006.
