Acetaminophen-induced acute liver injury, acute liver failure occurs more in women

SAN DIEGO — Despite increased rates of acetaminophen-induced acute liver injury and acute liver failure than male counterparts, women did not experience poorer survival outcomes related to these conditions, according to findings presented at Digestive Disease Week 2016.

Jessica Rubin, MD, MPH, of the department of medicine at the University of California San Francisco, and colleagues investigated how acute liver injury and acute liver failure due to acetaminophen toxicity differ between men and women. Specifically, they looked at how these conditions present and progress and how outcomes are different between the two sexes.

Jessica Rubin

“Although acetaminophen is the most common cause of acute liver injury and acute liver failure worldwide, the pathogenesis of these complications is unclear,” Rubin said.

Data for patients enrolled in the U.S. Acute Liver Failure Study Group between January 2000 and July 2015 were included. “We were looking at sex differences in presentation and hospital course,” she said. “We assessed overall survival and transplant-free survival at 21 days.”

The analysis included 1,066 patients. There were 202 patients with acute liver injury and 864 patients with acute liver failure. “The remainder of this talk will deal with the 864 acute liver failure patients,” Rubin said.

She reported on data for 654 women and 210 men.

Women with acetaminophen-induced acute liver failure had a median age of 37 years at presentation, while men were 33 years old (P < .001).

Comorbid psychiatric disease was more common in women, 60% vs. 47% (P = .009). However, the researchers reported no differences between the sexes in terms of suicidal intent as a reason for taking acetaminophen.

Median ALT was 3,430 among women, compared with 4,701 for men (P = .018). Women also had lower median MELD scores at admission, 32 vs. 35 (P < .001).

Intubation rates were higher in women, as were rates of receiving mannitol. Encephalopathy rates were 59% for women and 42% men.

Similar rates of need for renal replacement therapy were reported for women and men.

Although multi-organ disease appeared more severe as a result of acetaminophen-induced acute liver failure, women had a 21-day overall survival rate of 77%, compared with 74% for men (P = .57). In addition, women also had similar rates of transplant-free survival as men, 68% vs. 67% (P = .63).

“Women were more likely to present with acetaminophen-induced acute liver injury and acute liver failure,” Rubin said. “Women also were more likely to have more critical care needs than men on admission and throughout hospitalization. However, this did not translate to significant differences between the sexes in terms of overall or transplant-free survival at 21 days.”

Reference:

Rubin J, et al. Abstract #352. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego.

Disclosures: Rubin reports no relevant financial disclosures.

Editor's Note: This item has been updated with additional information from the presenter.