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IMPACT OF ALCOHOL ABUSE, LIVER DISEASE AND UNINTENTIONAL OVERDOSES ON OUTCOMES OF ACETAMINOPHEN OVERDOSE (AO): A POPULATION-BASED STUDY

RP Myers¹, B Li², S Dean², AM Shaheen¹, H Quan²
¹Liver Unit, Department of Medicine; ²Department of Community Health Sciences, University of Calgary, Calgary, Alberta

BACKGROUND: AO is the most common cause of acute liver failure. Referral center studies suggest that AO is more severe in patients with accidental overdoses, liver disease and alcohol abuse. The objectives of this study were to examine outcomes of AO from a population-based perspective including the impact of overdose circumstance and comorbidities.
METHODS: Hospitalized patients with AO in the Calgary Health Region (1995-2004) were identified from hospital discharge data. Comorbidities and outcomes (including acetaminophen hepatotoxicity [AH]), were identified using ICD-9-CM/10 codes. Risk factors for AH and in-hospital mortality were determined using multiple logistic regression. Long-term mortality was examined using Cox proportional hazards regression.
RESULTS: 2,159 patients were hospitalized for AO (67% female; median age 29 yr [range, 0-100]). 31% were alcohol abusers and 6% had liver disease. The proportion of unintentional overdoses (19%) increased with advancing age (<30 yr [10%] vs 30-49 yr [19%] vs =>50 yr [54%]; P<0.0005). Overall, 99 patients (4.6%) developed AH and 23 (1.1%) died. Liver disease (OR 284; 95% CI 119-677), unintentional overdoses (2.89; 1.08-7.74), and NAC treatment (3.28; 1.43-7.54) were associated with AH after adjustment for age, sex and alcohol abuse. In-hospital death was more common in males (P=0.03), older patients (P<0.0005), unintentional overdoses (P<0.0005) and patients with liver disease (P<0.0005), additional comorbidities (P<0.0005), and AH (12.1% vs 0.5%; P<0.0005). During a median follow-up of 5.0 yr (1 day-10.2 yr), 6.8% died; nearly half due to preventable conditions including suicide, trauma, and drug and alcohol-related disorders.
CONCLUSIONS: In this population-based study, AO had a relatively benign short-term course, but was associated with substantial long-term mortality due to preventable conditions. AH and in-hospital mortality were more frequent in patients with liver disease and unintentional overdoses, but not alcohol abusers.

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