Hepatitis C is a predictor of acute liver injury among hospitalizations for acetaminophen overdose in the United States: A nationwide analysis†
Open accessAbstract
UNLABELLED: Acute liver injury (ALI) following acetaminophen overdose (AO) occurs in less than 10% of cases, but that risk is increased among alcoholics and those with chronic alcoholic liver disease. We sought to assess whether coexistent hepatitis C virus (HCV) infection potentiated the hepatotoxic effects of acetaminophen. We queried the Nationwide Inpatient Sample (1998-2005), a 20% sample of U.S. hospitals, to identify admissions for AO using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Outcomes were development of ALI (ICD-9-CM: 570.0, 572.2, 573.3), in-hospital mortality, severe liver failure, and resource utilization. There were 42,781 admissions for AO in the sample, yielding a national estimate of 210,436 AO hospitalizations. HCV prevalence increased from 0.5% to 1.5% between 1998 and 2005 (P < 0.0001). The rate of ALI was 7.2%. After adjusting for confounders and excluding patients with cirrhosis, the risk of ALI increased with HCV (adjusted odds ratio [aOR] 1.80; 95% confidence interval [CI]: 1.30-2.48), nonalcoholic fatty liver disease (aOR 7.43; 95% CI: 3.30-16.7), alcoholic liver disease (aOR 6.46; 95% CI: 4.53-9.21), and malnutrition (aOR 3.84; 95% CI: 2.61-5.65). HCV was associated with greater risk of progression to severe liver failure (aOR 3.55; 95% CI: 1.88-6.70). Crude mortality was higher in patients with HCV compared to those without HCV (2.1% versus 0.9%, P = 0.01); patients with ALI had an overall mortality of 8.6%. Length of stay was longer in patients with HCV (4.0 versus 2.6 days, P < 0.0001). Admissions with coexistent HCV also incurred two-fold higher hospital charges than those that did not ($21,400 versus $11,400, P < 0.0001). CONCLUSION: Our retrospective analysis suggests that patients with HCV may be at increased risk of ALI following AO. These findings warrant further confirmation in prospective studies.
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A large retrospective study in the US found significantly increased risk of acute liver injury in people infected with hepatitis C virus, and people with nonalcoholic fatty liver disease (NAFLD).
“A large retrospective study in the US found significantly increased risk of acute liver injury in people infected with hepatitis C virus, and people with nonalcoholic fatty liver disease (NAFLD) [44].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [44]
Individuals who are fasting, malnourished, or anorexic are at increased risk for toxicity due to lower glutathione levels.
“Individuals who are fasting, malnourished, or anorexic are at increased risk for toxicity due to lower glutathione levels [44].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [44]
NAFLD has also been identified as a risk factor for hepatic injury following paracetamol overdose.
“NAFLD has also been identified as a risk factor for hepatic injury following paracetamol overdose [44].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [44]
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- Authors
- Nguyen, G. C., Sam, J., & Thuluvath, P. J.
- Affiliations
- Mount Sinai Hospital (CA)
- Corresponding author
- Nguyen, Geoffrey C.
- Thuluvath, Paul J.
- Venue
- Hepatology
- Published
- 2008-10
- Volume
- 48
- Issue
- 4
- Pages
- 1336-1341
- ISSN
- 0270-9139 (ISSN-L)
- OpenAlex
- W2092869863
- Cited by
- 107
- References
- 34
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 1 · 2023: 9 · 2022: 4 · 2021: 4 · 2020: 3 · 2019: 7 · 2018: 10 · 2017: 8 · 2016: 4 · 2015: 7 · 2014: 7 · 2013: 9 · 2012: 4
- FWCI
- 6.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Gastroenterological Association
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Health Sciences › Medicine › Hepatology › Hepatitis C virus research
- Keywords
- hepatitis C virus, acetaminophen overdose, acute liver injury, hepatotoxicity, non-alcoholic fatty liver disease, alcoholic liver disease, malnutrition, severe liver failure, in-hospital mortality, length of hospital stay, hospital resource utilization, HCV prevalence, risk factors, drug-induced liver injury, alcoholism, liver cirrhosis, hospitalization, United States, National Inpatient Sample
- MeSH terms
- Acetaminophen, Adult, Female, Health Surveys, Hepatitis C, Hospitalization, Humans, Inpatients, Male, Predictive Value of Tests, Respiratory Distress Syndrome, Retrospective Studies, Risk Factors, United States, Prevalence, Analgesics, Non-Narcotic, Drug Overdose
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