Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Clin Toxicol (Phila). 2011 Aug;49(7):664-7. doi: 10.3109/15563650.2011.597031. Epub 2011 Aug 8.
The risk of hepatotoxicity secondary to acute acetaminophen overdose is related to serum acetaminophen concentration and lag time from ingestion to N-acetylcysteine (NAC) therapy. Psi (Greek letter ψ) is a toxicokinetic parameter that takes the acetaminophen level at 4 h post-ingestion ([APAP](4 h)) and the time-to-initiation of NAC (tNAC) into account and was found to be significantly predictive of hepatotoxicity in Canadian patients with acetaminophen overdose treated with intravenous NAC.
We report the relationship of psi and hepatotoxicity in a Thai population with acute acetaminophen overdose.
This is a retrospective study of patients with acute paracetamol overdose during January 2004 to June 2009 at Siriraj Hospital. Patients were treated with the standard 21-h intravenous NAC regimen. Univariate analyses were performed with logistic regression to assess the relationships of psi, [APAP](4 h), and tNAC, and hepatotoxicity.
A total of 127 patients were enrolled. The median (interquartile range; IQR) of [APAP](4 h) was 267.8 (196.0-380.0) mg/L. The median (IQR) of tNAC was 8.5 (6.2-12.0) h. Thirteen patients (10.2%) developed hepatotoxicity. Univariate analysis revealed [APAP](4 h), tNAC, and psi as statistically significant predictors of hepatotoxicity.
The psi parameter is a reliable prognostic tool to predict hepatotoxicity secondary to acute acetaminophen overdose treated with intravenous NAC. Our evidence shows that psi may be a more superior tool than either acetaminophen level or time-to-initiation of NAC at predicting hepatotoxicity.
继发于急性对乙酰氨基酚过量的肝毒性风险与血清对乙酰氨基酚浓度以及从摄入到开始使用 N-乙酰半胱氨酸（NAC）治疗的时间滞后有关。Psi（希腊字母 ψ）是一个毒代动力学参数，考虑了摄入后 4 小时的对乙酰氨基酚水平（[APAP](4 h)）和开始使用 NAC 的时间（tNAC），并在接受静脉内 NAC 治疗的加拿大对乙酰氨基酚过量患者中被发现对肝毒性具有显著的预测作用。
我们报告了 Psi 与泰国急性对乙酰氨基酚过量患者肝毒性的关系。
这是一项回顾性研究，纳入了 2004 年 1 月至 2009 年 6 月在 Siriraj 医院就诊的急性扑热息痛过量患者。患者接受了标准的 21 小时静脉内 NAC 治疗方案。使用逻辑回归进行单变量分析，以评估 Psi、[APAP](4 h)和 tNAC 与肝毒性的关系。
共纳入 127 例患者。[APAP](4 h)的中位数（四分位距；IQR）为 267.8（196.0-380.0）mg/L。tNAC 的中位数（IQR）为 8.5（6.2-12.0）小时。13 例患者（10.2%）发生了肝毒性。单变量分析显示，[APAP](4 h)、tNAC 和 Psi 是肝毒性的统计学显著预测因素。
Psi 参数是预测接受静脉内 NAC 治疗的急性对乙酰氨基酚过量继发肝毒性的可靠预后工具。我们的证据表明，Psi 可能是预测肝毒性的比乙酰氨基酚水平或开始使用 NAC 的时间更优越的工具。
