Evidence map›Paper›PMID 38994834›Full record

Observational studyThe American journal of gastroenterology2025

Association of Acetaminophen (Paracetamol) Use With Severity and Outcomes in Patients With Viral Hepatitis-Associated Acute Liver Failure.

William M Lee, Carson Barnard, Jody A Rule, Babak J Orandi, Laura P James, R Todd Stravitz, Valerie Durkalski, Robert J Fontana, Acute Liver Failure Study Group

Abstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in The American journal of gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
  2. Review
  3. Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

William M LeeDivision of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA.ORCID 0000-0002-2783-5441
Carson BarnardDivision of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA.ORCID 0000-0003-4620-6306
Jody A RuleDivision of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA.ORCID 0000-0002-4019-372
Babak J OrandiDepartments of Surgery and Medicine, New York University, New York, New York, USA.ORCID 0000-0001-6026-7135
Laura P JamesArkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.ORCID 0000-0002-4266-3924
R Todd StravitzSection of Hepatology, Virginia Commonwealth University, Richmond, Virginia, USA.ORCID 0000-0001-9901-854
Valerie DurkalskiDepartment of Public Health, Medical University of South Carolina, Charleston, South Carolina, USA.
Robert J FontanaDivision of Gastroenterology and Hepatology, University of Michigan Medical School, Ann Arbor, Michigan, USA .ORCID 0000-0001-9161-5892
Acute Liver Failure Study Group

Funding

A Multi-Center Study of Acute Liver Failure in AdultsU01DK058369 · NIDDK · UT SOUTHWESTERN MEDICAL CENTER · PI DURKALSKI, VALERIE L, FONTANA, ROBERT J · 2005 to 2019
$27.4M
Adduct Dipstick for Diagnosis of Acetaminophen ToxicityR42DK079387 · NIDDK · ACETAMINOPHEN TOXICITY DIAGNOSTICS, LLC · PI JAMES, LAURA PHILLIPS · 2011 to 2018
$4.4M
A MULTI-CENTER THERAPY TRIAL FOR ACUTE LIVER FAILURER01DK058369 · NIDDK · UNIVERSITY OF TEXAS SW MED CTR/DALLAS · PI LEE, WILLIAM M · 2000 to 2004
$4.2M
NIDDK NIH HHS 2R42 DK079387NIDDK NIH HHS R-01 DK 058369NIDDK NIH HHS R01 DK058369NIDDK NIH HHS R42 DK079387NIDDK NIH HHS U-01 DK 058369NIDDK NIH HHS U01 DK058369
6 · The paper itself

Abstract

introductionAcute viral hepatitis (AVH) comprises 11% of acute liver failure (ALF) in North America while acetaminophen (APAP) toxicity represents 46%. The use of APAP to treat prodromal hepatitis symptoms is common. It is unknown if concurrent APAP use impacts liver injury in AVH-induced ALF.

methodsIn this prospective, multicenter cohort study, 356 patients meeting criteria for AVH including hepatitis A, B, Epstein-Barr virus, and herpes simplex virus, all leading to ALF (hepatic encephalopathy after acute illness, international normalized ratio ≥1.5), or acute liver injury (acute liver injury, international normalized ratio >2.0, no hepatic encephalopathy) were reviewed for evidence of APAP use: APAP ingestion history or measurement of serum APAP level or APAP-CYS adducts, a specific biomarker released into blood with APAP injury. Patients were grouped by APAP exposure level, from high (measurable APAP levels or toxic APAP-CYS), medium (therapeutic APAP-CYS), low (history of APAP ingestion only and/or barely detectable APAP-CYS), or no exposure recorded.

resultsTwo hundred five of 356 patients (57.5%) with AVH-ALF had evidence of APAP use: 87 out of 356 (24%) demonstrated high or medium exposures. The aminotransferase and bilirubin levels of high/medium group resembled a mixed APAP-viral injury. Mortality was the highest (51.6%, 21.4%, 28.8%, and 30.5%), and transplant-free survival was the lowest (22.6%, 44.6%, 41.5%, and 40.4%) in the high exposure group compared with medium, low, and no exposure groups. However, the specific comparisons of mortality and transplant-free survival between the high exposure and no exposure groups were not statistically different even after adjusting for baseline patient characteristics differences. DISCUSSION: APAP use in AVH-ALF is common and may negatively impact outcomes compared with little or no APAP exposure. Prospective studies of the safest and effective dose of APAP to use in patients with AVH are needed.

Indexed as

AcetaminophenAnalgesics, Non-NarcoticChemical and Drug Induced Liver InjuryHepatitis, Viral, HumanLiver Failure, AcuteAdultFemaleHumansLiver TransplantationMaleMiddle AgedProspective StudiesSeverity of Illness IndexAcetaminophenAnalgesics, Non-Narcotic

Identifiers

PMID38994834
PMCPMC11724933

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.