Analysis of the Australia and New Zealand referral criteria for transfer to a liver unit for paracetamol overdose. (4th May 2021)

• Record Type: Journal Article
• Authors: Xu, Yifan; Testro, Adam; Wong, Anselm
• Is Part Of: Emergency medicine Australasia. Volume 33:Number 6(2021)
• Page Start: 1021
• Page End: 1026
• Publication Date: 2021-05-04
• Subjects: acetaminophen -- hepatic failure -- prognostication -- toxicity; Emergency medicine -- Periodicals; Emergency medicine -- Australasia -- Periodicals; 616.025
• DOI: 10.1111/1742-6723.13795
• Languages: English
• ISSNs: 1742-6731

Abstract

Abstract: Objectives: Paracetamol overdose is common and can lead to fulminant hepatic failure. In cases that are not improving with standard medical therapy with N ‐acetylcysteine, some patients may require liver transplant. The Australia and New Zealand (ANZ) referral criteria for transfer to a liver unit have not been extensively studied for its predictive value. The aim of this study was to evaluate the ANZ referral criteria for predicting mortality in paracetamol overdose. Methods: This study involves a retrospective analysis of patients who developed hepatotoxicity post‐paracetamol overdose presenting to an Australian health service with a liver transplant unit between 2010 and 2019 and were treated with N ‐acetylcysteine. The primary outcome was death or transplant. Results: Out of 983 paracetamol overdose presentations, 81 (8.2%) cases developed hepatotoxicity. Of these, 17 cases (21%) met the composite endpoint of death or transplant. The ANZ referral criteria is highly sensitive at predicting the primary endpoint of death or transplant at time of referral 100% (95% confidence interval 81–100) but had low specificity at 30% (95% confidence interval 19–42). Conclusions: The ANZ referral criteria were highly sensitive for predicting the outcome of mortality and transplant. This is important for screening patients who may become unstable and difficult to transfer at a later stage of their admission. Abstract : The ANZ referral criteria were highly sensitive for predicting the outcome of mortality and transplant. This is important for screening patients that may become unstable and difficult to transfer at a later stage of their admission.