Augmenting the sensitivity for hepatotoxicity prediction in acute paracetamol overdose: combining psi (ψ) parameter and paracetamol concentration aminotransferase activity multiplication product.

IF 3 3区 医学 Q2 TOXICOLOGY Clinical Toxicology Pub Date : 2024-11-01 Epub Date: 2024-11-04 DOI:10.1080/15563650.2024.2412208
Summon Chomchai, Pattaraporn Mekavuthikul, Jariya Phuditshinnapatra, Chulathida Chomchai
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Abstract

Introduction: While factors like high serum paracetamol (acetaminophen) concentration and delayed acetylcysteine treatment increase hepatotoxicity risk, existing predictive tools, such as the paracetamol concentration aminotransferase activity multiplication product and the psi (ψ) parameter, lack definitive accuracy. This study evaluated the paracetamol psi parameter multiplication product addition against the psi parameter and the paracetamol concentration aminotransferase activity multiplication product for predicting hepatotoxicity following an acute paracetamol overdose.

Methods: A retrospective analysis of patients with acute paracetamol overdose from January 2007 to December 2016 was conducted. The paracetamol psi parameter multiplication product addition, calculated by summing the psi parameter (mmol/L × h) and the paracetamol concentration aminotransferase activity multiplication product (g U/L2), was used. Hepatotoxicity was defined as aspartate or alanine aminotransferase activities ≥1,000 U/L. Diagnostic accuracy was assessed through sensitivity, specificity, the area under the receiver operating characteristic curve, and their corresponding 95% CI, with the optimal cutoff determined using the maximum Youden index method.

Results: The study comprised 421 patients, mostly female (82.9%) with a median age of 23 years. Hepatotoxicity occurred in 13.5% (57 patients). The paracetamol psi parameter multiplication product addition showed an area under the receiver operating characteristic curve of 0.989 (95% CI: 0.974-0.997), with an optimal cutoff at 9.723, providing 96.5% sensitivity and 97.3% specificity. The paracetamol psi parameter multiplication product addition demonstrated superior performance in area under the receiver operating characteristic curve compared to the individual assessments of the psi parameter (0.916; 95% CI: 0.885-0.941) and the paracetamol concentration aminotransferase activity multiplication product (0.901; 95% CI: 0.868-0.928).

Discussion: The paracetamol psi parameter multiplication product addition appears to be a more effective diagnostic tool than the psi parameter or the paracetamol concentration aminotransferase activity multiplication product alone.

Conclusion: Incorporating the paracetamol psi parameter multiplication product addition into clinical protocols could improve paracetamol overdose management by enabling precise identification of individuals at heightened risk for hepatotoxicity, thereby facilitating the customization of treatment approaches.

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提高急性扑热息痛过量时肝脏毒性预测的灵敏度:结合 psi (ψ) 参数和扑热息痛浓度氨基转移酶活性乘积。
导言:虽然高血清对乙酰氨基酚(对乙酰氨基酚)浓度和延迟乙酰半胱氨酸治疗等因素会增加肝毒性风险,但现有的预测工具,如对乙酰氨基酚浓度转氨酶活性乘积和psi(ψ)参数,缺乏明确的准确性。本研究评估了扑热息痛psi参数乘积加法与psi参数和扑热息痛浓度转氨酶活性乘积的对比,以预测急性扑热息痛过量后的肝毒性:对2007年1月至2016年12月期间急性扑热息痛过量患者进行了回顾性分析。采用扑热息痛psi参数乘积加法,计算方法是将psi参数(mmol/L × h)与扑热息痛浓度转氨酶活性乘积(g U/L2)相加。肝毒性的定义是天冬氨酸或丙氨酸氨基转移酶活性≥1,000 U/L。诊断准确性通过灵敏度、特异性、接收者操作特征曲线下面积及其相应的 95% CI 进行评估,最佳临界值采用最大尤登指数法确定:研究共涉及 421 名患者,大部分为女性(82.9%),中位年龄为 23 岁。肝毒性发生率为 13.5%(57 名患者)。扑热息痛 psi 参数乘积加法的接收者工作特征曲线下面积为 0.989(95% CI:0.974-0.997),最佳临界值为 9.723,灵敏度为 96.5%,特异性为 97.3%。与psi参数(0.916;95% CI:0.885-0.941)和扑热息痛浓度转氨酶活性乘积(0.901;95% CI:0.868-0.928)的单独评估相比,扑热息痛psi参数乘积加法在接收器操作特征曲线下面积方面表现更优:讨论:与psi参数或扑热息痛浓度转氨酶活性乘积相比,扑热息痛psi参数乘积加法似乎是更有效的诊断工具:将扑热息痛psi参数乘积加法纳入临床方案,可以精确识别肝毒性风险较高的个体,从而改进扑热息痛过量管理,促进治疗方法的定制化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Toxicology
Clinical Toxicology 医学-毒理学
CiteScore
5.70
自引率
12.10%
发文量
148
审稿时长
4-8 weeks
期刊介绍: clinical Toxicology publishes peer-reviewed scientific research and clinical advances in clinical toxicology. The journal reflects the professional concerns and best scientific judgment of its sponsors, the American Academy of Clinical Toxicology, the European Association of Poisons Centres and Clinical Toxicologists, the American Association of Poison Control Centers and the Asia Pacific Association of Medical Toxicology and, as such, is the leading international journal in the specialty.
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