Tujios Shannan R, Wees Isabel, Anouti Ahmad, Gottfried Michelle, Almandoz Jaime, Durkalski Valerie, Rule Jody A, Fontana Robert J, Lee William M
Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, Texas, USA.
Clin Transl Gastroenterol. 2025 May 13;16(7):e00852. doi: 10.14309/ctg.0000000000000852. eCollection 2025 Jul 1.
Prior small studies have suggested that patients with prior metabolic and bariatric surgery (MBS) may have increased susceptibility to acetaminophen (APAP)-related acute liver failure/acute liver injury (ALF/ALI). The aim of this study was to compare the presentation, etiology, and outcome of adult ALI/ALF patients who were enrolled in a prospective registry study with prior bariatric surgery to those without.
Among 3,364 ALF/ALI patients in the Acute Liver Failure Study Group registry enrolled between January 1998 and August 2019, 85 (2.3%) reported prior MBS. On review, 6 cases were deemed not ALF and excluded from the analysis.
Among the 79 MBS ALF/ALI patients, 95% were female and 86% were White. Etiology included APAP-related ALF/ALI in 78.5% of the MBS group vs 49.3% in the non-MBS group ( P < 0.001). The proportion of patients with MBS increased from 1.6% (1998-2008) to 3.4% in the later years (2009-2019) ( P < 0.001). There were proportionately more unintentional overdoses in the MBS cohort (71% vs 52%, P < 0.001) with smaller median total APAP dose ingestion (6,500 mg vs 12,000 mg, P = 0.009). Although MBS patients had more severe encephalopathy at presentation, overall, 21-day and transplant-free survival between the groups were similar.
ALF/ALI is more frequent in MBS patients than in the general population. APAP toxicity is the most common cause in MBS patients but not the only diagnosis observed. MBS may predispose to severe unintentional APAP liver injury at lower doses. Both MBS patients and providers should be aware regarding this potential risk of increased susceptibility to APAP hepatotoxicity.
先前的小型研究表明，曾接受代谢和减重手术（MBS）的患者可能对乙酰氨基酚（APAP）相关的急性肝衰竭/急性肝损伤（ALF/ALI）更为易感。本研究的目的是比较纳入前瞻性登记研究的有减重手术史的成年ALI/ALF患者与无减重手术史的患者的临床表现、病因及预后。
在1998年1月至2019年8月登记的急性肝衰竭研究组登记的3364例ALF/ALI患者中，85例（2.3%）报告有先前的MBS。经审查，6例被认为不属于ALF并被排除在分析之外。
在79例MBS-ALF/ALI患者中，95%为女性，86%为白人。病因方面，MBS组中78.5%为APAP相关的ALF/ALI，而非MBS组为49.3%（P<0.001）。有MBS的患者比例从1998 - 2008年的1.6%增加到后期（2009 - 2019年）的3.4%（P<0.001）。MBS队列中无意过量用药的比例相对较高（71%对52%，P<0.001），APAP总摄入量的中位数较小（6500毫克对12000毫克，P = 0.009）。虽然MBS患者在就诊时脑病更严重，但总体而言，两组之间的21天生存率和无移植生存率相似。
MBS患者中ALF/ALI比一般人群更常见。APAP毒性是MBS患者最常见的病因，但不是唯一观察到的诊断。MBS可能使患者在较低剂量下易发生严重的无意APAP肝损伤。MBS患者和医疗服务提供者都应意识到对APAP肝毒性易感性增加的这种潜在风险。
