Comparison of Prothrombin Time and Aspartate Aminotransferase in Predicting Hepatotoxicity After Acetaminophen Overdose

Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology
Michael LevineRichard D Gerkin

Abstract

Despite decades of experience with acetaminophen (APAP) overdoses, it remains unclear whether elevated hepatic transaminases or coagulopathy develop first. Furthermore, comparison of the predictive value of these two variables in determining hepatic toxicity following APAP overdoses has been poorly elucidated. The primary objective of this study is to determine the test characteristics of the aspartate aminotransferase (AST) and the prothrombin time (PT) in patients with APAP toxicity. A retrospective chart review of APAP overdoses treated with IV N-acetylcysteine at a tertiary care referral center was performed. Of the 304 subjects included in the study, 246 with an initial AST less than 1000 were analyzed to determine predictors of hepatic injury, defined as an AST exceeding 1000 IU/L. The initial AST >50 was 79.5 % sensitive and 82.6 % specific for predicting hepatic injury. The corresponding negative and positive predictive values were 95.5 and 46.3 %, respectively. In contrast, an initial abnormal PT had a sensitivity of 82.1 % and a specificity of 63.6 %. The negative and positive predictive values for initial PT were 94.9 and 30.2 %, respectively. Although the two tests performed similarly for predicting a composite endp...Continue Reading

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Citations

Apr 28, 2017·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Anselm Wong, Andis Graudins
Jul 27, 2018·Critical Reviews in Clinical Laboratory Sciences·Yesim OzardaUNKNOWN IFCC Committee on Reference intervals and Decision Limits (C-RIDL)
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Nov 18, 2015·Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology·Denise Fernandez, Lewis S Nelson
Jun 13, 2020·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Michael E Mullins, Donna L Seger
Nov 15, 2015·Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology·Michael LevineRichard Gerkin
May 11, 2020·Current Drug Targets·Silvio Terra StefanelloRômulo Pillon Barcelos
Oct 24, 2020·Scientifica·Murad N AbualhasanNael S Abu-Hasan

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