丙型肝炎是美国对乙酰氨基酚过量导致住院患者急性肝损伤的一个预测指标：一项全国性分析。

Hepatitis C is a predictor of acute liver injury among hospitalizations for acetaminophen overdose in the United States: a nationwide analysis.

作者信息

Nguyen Geoffrey C, Sam Justina, Thuluvath Paul J

机构信息

Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

出版信息

Hepatology. 2008 Oct;48(4):1336-41. doi: 10.1002/hep.22536.

DOI:10.1002/hep.22536

PMID:18821593

Abstract

UNLABELLED

Acute liver injury (ALI) following acetaminophen overdose (AO) occurs in less than 10% of cases, but that risk is increased among alcoholics and those with chronic alcoholic liver disease. We sought to assess whether coexistent hepatitis C virus (HCV) infection potentiated the hepatotoxic effects of acetaminophen. We queried the Nationwide Inpatient Sample (1998-2005), a 20% sample of U.S. hospitals, to identify admissions for AO using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Outcomes were development of ALI (ICD-9-CM: 570.0, 572.2, 573.3), in-hospital mortality, severe liver failure, and resource utilization. There were 42,781 admissions for AO in the sample, yielding a national estimate of 210,436 AO hospitalizations. HCV prevalence increased from 0.5% to 1.5% between 1998 and 2005 (P < 0.0001). The rate of ALI was 7.2%. After adjusting for confounders and excluding patients with cirrhosis, the risk of ALI increased with HCV (adjusted odds ratio [aOR] 1.80; 95% confidence interval [CI]: 1.30-2.48), nonalcoholic fatty liver disease (aOR 7.43; 95% CI: 3.30-16.7), alcoholic liver disease (aOR 6.46; 95% CI: 4.53-9.21), and malnutrition (aOR 3.84; 95% CI: 2.61-5.65). HCV was associated with greater risk of progression to severe liver failure (aOR 3.55; 95% CI: 1.88-6.70). Crude mortality was higher in patients with HCV compared to those without HCV (2.1% versus 0.9%, P = 0.01); patients with ALI had an overall mortality of 8.6%. Length of stay was longer in patients with HCV (4.0 versus 2.6 days, P < 0.0001). Admissions with coexistent HCV also incurred two-fold higher hospital charges than those that did not ($21,400 versus $11,400, P < 0.0001).

CONCLUSION

Our retrospective analysis suggests that patients with HCV may be at increased risk of ALI following AO. These findings warrant further confirmation in prospective studies.

摘要

未标注

对乙酰氨基酚过量服用（AO）后发生急性肝损伤（ALI）的情况不到10%，但在酗酒者和患有慢性酒精性肝病的人群中该风险会增加。我们试图评估丙型肝炎病毒（HCV）合并感染是否会增强对乙酰氨基酚的肝毒性作用。我们查询了全国住院患者样本（1998 - 2005年），这是美国医院20%的样本，使用国际疾病分类第九版临床修订本（ICD - 9 - CM）编码来确定AO的住院病例。结局指标为ALI的发生（ICD - 9 - CM：570.0、572.2、573.3）、住院死亡率、严重肝衰竭以及资源利用情况。样本中有42781例AO住院病例，据此估算全国AO住院病例数为210436例。1998年至2005年间，HCV患病率从0.5%增至1.5%（P < 0.0001）。ALI发生率为7.2%。在对混杂因素进行校正并排除肝硬化患者后，ALI风险随HCV（校正比值比[aOR] 1.80；95%置信区间[CI]：1.30 - 2.48）、非酒精性脂肪性肝病（aOR 7.43；95% CI：3.30 - 16.7）、酒精性肝病（aOR 6.46；95% CI：4.53 - 9.21）和营养不良（aOR 3.84；95% CI：2.61 - 5.65）而增加。HCV与进展至严重肝衰竭的更高风险相关（aOR 3.55；95% CI：1.88 - 6.70）。HCV患者的粗死亡率高于无HCV患者（2.1%对0.9%，P = 0.01）；ALI患者的总体死亡率为8.6%。HCV患者的住院时间更长（4.0天对2.6天，P < 0.0001）。合并HCV的住院病例的医院费用也比未合并者高出两倍（21400美元对11400美元，P < 0.0001）。