Measurement of serum acetaminophen-protein adducts in patients with acute liver failure.

Abstract:

BACKGROUND & AIMS:Acetaminophen toxicity is the most common cause of acute liver failure (ALF) in the United States and Great Britain, but may be underrecognized in certain settings. Acetaminophen-protein adducts are specific biomarkers of drug-related toxicity in animal models and can be measured in tissue or blood samples. Measurement of serum adducts might improve diagnostic accuracy in acute liver failure (ALF) patients. METHODS:We measured serum acetaminophen-protein adducts using high-pressure liquid chromatography with electrochemical detection in coded sera of 66 patients with ALF collected prospectively at 24 US tertiary referral centers. Samples were included from 20 patients with well-characterized acetaminophen-related acute liver failure, 10 patients with ALF owing to other well-defined causes, 36 patients with ALF of indeterminate etiology, and 15 additional patients without ALF but with known acetaminophen overdose and minimal or no biochemical liver injury. RESULTS:Acetaminophen-protein adducts were detected in serum in 100% of known acetaminophen ALF patients and in none of the ALF patients with other defined causes, yielding a sensitivity and specificity of 100%. In daily serial samples, serum adducts decreased in parallel with aminotransferase levels. Seven of 36 (19%) indeterminate cases demonstrated adducts in serum suggesting that acetaminophen toxicity caused or contributed to ALF in these patients. Low adduct levels were present in 2 of 15 patients with acetaminophen overdose without significant liver injury. CONCLUSIONS:Measurement of serum acetaminophen-protein adducts reliably identified acetaminophen toxicity, and may be a useful diagnostic test for cases lacking historical data or other clinical information.

journal_name

Gastroenterology

journal_title

Gastroenterology

authors

Davern TJ 2nd,James LP,Hinson JA,Polson J,Larson AM,Fontana RJ,Lalani E,Munoz S,Shakil AO,Lee WM,Acute Liver Failure Study Group.

doi

10.1053/j.gastro.2006.01.033

keywords:

subject

Has Abstract

pub_date

2006-03-01 00:00:00

pages

687-94

issue

3

eissn

0016-5085

issn

1528-0012

pii

S0016-5085(06)00039-4

journal_volume

130

pub_type

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