Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand.
Clin Toxicol (Phila). 2014 Jun;52(5):506-11. doi: 10.3109/15563650.2014.917180. Epub 2014 May 20.
Prediction of potential hepatotoxicity is important for individualizing therapy with N-acetylcysteine (NAC) in patients with acute acetaminophen overdose. Acetaminophen-aminotransferase multiplication product (APAP × AT) and the Psi Parameter (Psi) have been reported to be the predictors of acetaminophen hepatotoxicity.
To determine the validity of APAP × AT and Psi in predicting hepatotoxicity secondary to acute acetaminophen overdose.
We retrospectively reviewed acute acetaminophen overdose cases who were treated with NAC at Siriraj Hospital, Thailand during January 2004-June 2012. The patients' ages were 12 years or more. Initial acetaminophen concentration (mg/L) and aminotransferase (IU/L) were multiplied to obtain APAP × AT. Psi were derived from initial acetaminophen concentrations (mg/L) and lag time (hours) to NAC therapy. The cut-off values for APAP × AT and Psi were 1500 mg∙IU/L(2) and 5 mM∙h, respectively. Hepatotoxicity (defined as aspartate or alanine aminotransferase (ALT) greater than 1000 IU/L) was the outcome of interest.
A total of 255 patients were included, 32 of whom developed hepatotoxicity. APAP × AT had sensitivity, specificity, and negative likelihood ratio of 90.6%, 62.8%, and 0.2, respectively. The sensitivity of Psi, specificity, and negative likelihood ratio were 96.9%, 91.5%, and 0.0, respectively. The areas under the curve of the receiver operating characteristic (ROC) curve for APAP × AT and Psi were 0.82 and 0.96, respectively, with a statistically significant difference between the two methods (p = 0.002). APAP × AT showed higher specificity (92.5%) in patients who presented 8-24 h after the overdose.
Psi and APAP × AT are valid clinical tools in predicting hepatotoxicity secondary to acute acetaminophen overdose in adults. APAP × AT is useful in predicting a low likelihood of hepatotoxicity after standard NAC therapy among late-presenting patients.
对于接受 N-乙酰半胱氨酸（NAC）治疗的急性对乙酰氨基酚过量患者，预测潜在肝毒性至关重要。已报道乙酰氨基酚-氨基转移酶倍增产物（APAP×AT）和 Psi 参数（Psi）是预测对乙酰氨基酚肝毒性的指标。
确定 APAP×AT 和 Psi 在预测急性对乙酰氨基酚过量后肝毒性的有效性。
我们回顾性分析了 2004 年 1 月至 2012 年 6 月在泰国诗里拉吉医院接受 NAC 治疗的急性对乙酰氨基酚过量病例。患者年龄为 12 岁或以上。初始对乙酰氨基酚浓度（mg/L）和氨基转移酶（IU/L）相乘得到 APAP×AT。Psi 是从初始对乙酰氨基酚浓度（mg/L）和 NAC 治疗的滞后时间（小时）得出的。APAP×AT 和 Psi 的截止值分别为 1500mg·IU/L（2）和 5mM·h。肝毒性（定义为天冬氨酸或丙氨酸氨基转移酶（ALT）大于 1000IU/L）是我们感兴趣的结果。
共纳入 255 例患者，其中 32 例发生肝毒性。APAP×AT 的敏感性、特异性和负似然比分别为 90.6%、62.8%和 0.2。Psi 的敏感性、特异性和负似然比分别为 96.9%、91.5%和 0.0。APAP×AT 和 Psi 的受试者工作特征（ROC）曲线下面积分别为 0.82 和 0.96，两种方法之间存在统计学差异（p=0.002）。APAP×AT 在服药后 8-24 小时就诊的患者中具有更高的特异性（92.5%）。
Psi 和 APAP×AT 是预测成人急性对乙酰氨基酚过量后肝毒性的有效临床工具。APAP×AT 可用于预测标准 NAC 治疗后晚就诊患者发生肝毒性的可能性较低。
