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Persistently elevated troponin I in paracetamol hepatotoxicity: association with liver injury, organ failure, and outcome.
- Source :
-
Clinical toxicology (Philadelphia, Pa.) [Clin Toxicol (Phila)] 2013 Aug; Vol. 51 (7), pp. 532-9. Date of Electronic Publication: 2013 Jul 05. - Publication Year :
- 2013
-
Abstract
- Context: An elevated troponin I (TnI) is associated with a poorer prognosis during critical illness.<br />Objective: Our aims were to determine whether significant paracetamol-induced hepatotoxicity was associated with an elevated TnI; if this elevation was persistent and was associated with worse clinical outcomes.<br />Materials and Methods: In this retrospective cohort study, the requirement for orthotopic liver transplantation (OLT) or death and/or the development of multiorgan failure (MOF) was evaluated for 48 consecutive patients admitted to the Royal Infirmary of Edinburgh (a university tertiary referral centre) with acute liver injury or acute liver failure secondary to paracetamol overdose.<br />Results: TnI was elevated (≥ 0.05 ng/L) in 13/48 patients (27%). This appeared to be sustained for at least 6 days which has not been shown previously in the context of Acute Liver Injury (ALI). Elevated TnI was strongly associated with MOF, with the requirement for inotropic support being the strongest predictor (p = 0.003, OR 9.00, 95% CI 2.13-37.98). TnI elevations also correlated strongly with Acute Physiology and Chronic Health Evaluation (APACHE) II scores (p = 0.0006, r = 0.482, 95% CI 0.22-0.68) and with interleukin 6 (IL-6) levels (p = 0.0001, r = 0.55, 95% CI 0.29-0.73). Although a raised TnI was associated with a markedly increased risk of death or orthotopic liver transplant (p = 0.005, OR 7.73, 95% CI 1.87-32.05) on univariate analysis, this was primarily seen in the context of MOF (SOFA score p = 0.003, OR 1.23, 95% CI 1.07-1.41) and was not an independent predictor of death. There was no correlation between TnI or outcome with other cardiac biomarkers and markers of cardiovascular risk.<br />Discussion and Conclusion: An elevated TnI in the context of acute liver injury or liver failure following paracetamol overdose is associated with a significantly worse patient outcome but it is not an independent prognostic factor. Further studies should be undertaken to investigate the mechanism behind this elevated troponin association.
- Subjects :
- APACHE
Adolescent
Adult
Aged
Biomarkers blood
Chemical and Drug Induced Liver Injury diagnosis
Chemical and Drug Induced Liver Injury etiology
Chemical and Drug Induced Liver Injury mortality
Chemical and Drug Induced Liver Injury surgery
Chi-Square Distribution
Female
Humans
Interleukin-6 blood
Liver Failure, Acute diagnosis
Liver Failure, Acute etiology
Liver Failure, Acute mortality
Liver Failure, Acute surgery
Liver Transplantation
Logistic Models
Male
Middle Aged
Multiple Organ Failure blood
Multiple Organ Failure etiology
Multiple Organ Failure mortality
Multivariate Analysis
Odds Ratio
Organ Dysfunction Scores
Prognosis
Retrospective Studies
Risk Assessment
Risk Factors
Scotland
Time Factors
Up-Regulation
Young Adult
Acetaminophen poisoning
Analgesics, Non-Narcotic poisoning
Chemical and Drug Induced Liver Injury blood
Liver Failure, Acute blood
Troponin I blood
Subjects
Details
- Language :
- English
- ISSN :
- 1556-9519
- Volume :
- 51
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Clinical toxicology (Philadelphia, Pa.)
- Publication Type :
- Academic Journal
- Accession number :
- 23829708
- Full Text :
- https://doi.org/10.3109/15563650.2013.816853