Acetaminophen-Related Liver Injury, Failure Is More Common in Women

Acetaminophen-induced acute liver injury (ALI) and acute liver failure (ALF) is more common and more severe in women than in men, according to a recent study.

Using data from the Acute Liver Failure Study Group cohort, the researchers evaluated data from 1162 patients with acetaminophen-induced ALI (n = 250) or ALF (n = 912) from January 2000 to September 2016.
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Information including patient presentation, disease course, medication use, and details of acetaminophen ingestion was assessed. Sex differences were determined in continuous and categorical variables.

Results of the analysis showed that the majority of patients who had developed ALI (68%) or ALF (76%) were women who had been simultaneously ingesting acetaminophen with sedating agents (70% of women vs 52% of men). Of the sedating agents used, more than half were opioids.

The researchers found that more women had severe hepatic encephalopathy (HE, 68% vs 58%) and required intubation (67% vs 59%) compared with men. Additionally, more women had used vasopressors (26% vs 19%) or mannitol (13% vs 6%) than men. The researchers noted that the proportions of men and women who achieved transplant-free survival had been similar (68%).

Adjusted analysis indicated that women had a higher risk of severe HE than men, and that co-ingestion doubled the risk of severe HE in women, but not in men.

“In an analysis of the Acute Liver Failure Study Group cohort, we found acetaminophen-induced ALI and ALF to be more common among women,” the researchers concluded. “Women have greater critical care needs than men, and increased risk for severe HE, which could be due in part to increased use of sedatives. Future studies should investigate sex differences in acetaminophen metabolism and hepatotoxicity, particularly among users of opioids.”

—Christina Vogt

Reference:

Rubin JB, Hameed B, Gottfried M, Lee WM, Sarkar M; Acute Liver Failure Study Group. Acetaminophen-induced acute liver failure is more common and more severe in women [Published online November 30, 2017]. Clin Infect Dis. http://www.cghjournal.org/article/S1542-3565(17)31415-5/fulltext?rss=yes.