Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan.
Department of Health Services Administration, China Medical University, Taichung, Taiwan.
J Appl Toxicol. 2018 May;38(5):766-772. doi: 10.1002/jat.3586. Epub 2018 Jan 11.
Acetaminophen poisoning increases cytochrome P450 2E1 expression and reactive oxygen species production, which may lead to maladaptive myocardial remodeling and congestive heart failure (CHF). We conducted a nationwide cohort study to investigate the incidence and risk of CHF in patients with acetaminophen poisoning. We identified a cohort of adult patients with newly diagnosed acetaminophen poisoning in the inpatient claims of the Taiwan National Health Insurance Research Database for the 1998-2011 period. A comparison cohort was frequency matched at a 4:1 ratio for sex, age and index year. All patients were followed up until the occurrence of CHF, withdrawal from the National Health Insurance program, or December 31, 2011. Cox proportional hazards models were employed to calculate the risk of CHF in the acetaminophen poisoning cohort compared with the comparison cohort, and the hazard ratios with 95% confidence intervals are presented. A total of 3546 and 14 184 patients with and without acetaminophen poisoning were followed up for a total of 25 856 and 102 119 person-years, respectively. The overall incidence of CHF was higher in the acetaminophen poisoning cohort than in the comparison cohort (8.12 vs. 5.19 per 10 000 person-years). After adjustment for covariates, the acetaminophen poisoning cohort exhibited a 1.59-fold higher risk of CHF (adjusted hazard ratio = 1.59; 95% confidence interval = 1.43-1.75) than did the comparison cohort. Patients with acetaminophen poisoning exhibited a significantly higher risk of CHF compared with the comparison cohort. Clinicians should follow up heart function in patients with acetaminophen poisoning.
对乙酰氨基酚中毒会增加细胞色素 P450 2E1 的表达和活性氧的产生，这可能导致适应性心肌重构和充血性心力衰竭 (CHF)。我们进行了一项全国性的队列研究，以调查对乙酰氨基酚中毒患者发生 CHF 的发病率和风险。我们在台湾全民健康保险研究数据库的住院患者索赔中确定了一个在 1998-2011 年期间新诊断为对乙酰氨基酚中毒的成年患者队列。一个比较队列按照性别、年龄和指数年以 4:1 的比例进行频率匹配。所有患者均随访至 CHF 发生、退出全民健康保险计划或 2011 年 12 月 31 日。Cox 比例风险模型用于计算与比较队列相比，对乙酰氨基酚中毒队列发生 CHF 的风险，并呈现风险比及其 95%置信区间。共有 3546 名和 14184 名有和没有对乙酰氨基酚中毒的患者分别随访了 25856 人和 102119 人年。CHF 的总发病率在对乙酰氨基酚中毒队列中高于比较队列（8.12 比 5.19/10000 人年）。调整混杂因素后，与比较队列相比，对乙酰氨基酚中毒队列发生 CHF 的风险高出 1.59 倍（调整后的危险比=1.59；95%置信区间=1.43-1.75）。与比较队列相比，对乙酰氨基酚中毒患者发生 CHF 的风险显著增加。临床医生应在对乙酰氨基酚中毒患者中随访心脏功能。
