Can we improve prognostic indications in acetaminophen-induced hepatic failure?
The objective was to compare the markers of hypoglycemia (glucose < 50 mg/dL,) coagulopathy, and lactic acidosis (lactate above hospital’s “normal” range) in predicting a composite endpoint of death or liver transplantation. The authors identified 334 unique cases. 19 of these were listed for transplant, and 13 actually received liver transplant. (2 transplanted patients subsequently died.) Although 96 patients (29%) met the King’s College Criteria, it is not clear how many of these who were not transplanted died. There were 40 deaths in all. After some statistical manipulation which was not at all nearly described, the authors conclude that: The combination of hypoglycemia, coagulopathy, and lactic acidosis performed better than the King’s College criteria for predicting death or transplant. I’d submit that “better” is really a helpful word in describing the permanence of these dueling criteria. Despite reading the paper several times, I could not tell exactly what the authors meant by “better.” In any case, I don’t think this study design could have met their objectives even for the purpose of a pilot study. The composite endpoint muddles everything. True, death is a firm, obvious outcome, but the decision to transplant is subjective, and certainly based in part on some of the criteria being tested.
Source: The Poison Review - Category: Toxicology Authors: Leon Gussow Tags: Medical acetaminophen poisoning hepatic failure king's college criteria liver transplantation Source Type: news
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