Table 3.
Outcome ALT ≥100 U/L, only those whose ALT at presentation was <100 U/L
| Metabolites/Biomarker | No acute liver injury (peak ALT < 100 U/L) (median) (IQR, [range], n) (n = 158) | (Peak ALT ≥ 100 U/L) (median) (IQR, [range], n) (n = 21) | Difference between medians (95% CI) | P value |
|---|---|---|---|---|
|
APAP‐hospital lab (μmol/L) |
686 (271–1,357, [3.3–5,614]) (n = 158) |
940 (504–2,815, [301–3,856]) (n = 21) |
254 (50 to 747) | 0.030 |
|
ALT (U/L) |
18 (14–25, [5–90]) (n = 156) |
40 (19–57, [14–78]) (n = 21) |
22 (6 to 26) | <0.0001 |
|
Acetaminophen Ratio |
1.0 (0.4–1.9, [0.0–10.3]) (n = 158) |
3.3 (11.8–6.0, [0.7–27.6]) (n = 21) |
2.3 (1.3 to 3.0) | <0.0001 |
| Acetaminophen metabolite | ||||
|
APAP‐LC/MS (μmol/L) |
685 (296–1,228, [7.7–4,634]) (n = 158) |
894 (493–2,140, [266–4,800]) (n = 21) |
209 (−29 to 597) | NS |
|
APAP‐Glu (μmol/L) |
472 (314–834, [16–3,529]) (n = 158) |
629 (425–990, [209–1,680]) (n = 21) |
157 (−38 to 312) | NS |
|
APAP‐Sul (μmol/L) |
79 (56–115, [9.7–350]) (n = 158) |
60 (37–95, [15–264]) (n = 21) |
−19 (−38 to 2.6) | NS |
|
APAP‐Cys (μmol/L) |
9.4 (5.9–15.8, [0.0–41.7]) (n = 158) |
30.1 (19.6–39.3, [7.2–85.9]) (n = 21) |
20.9 (14.0 to 25.2) | <0.0001 |
|
APAP‐Mer (μmol/L) |
1.1 (0.6–2.1, [0.0–16.3]) (n = 158) |
2.7 (1.5–3.6, [0.4–9.2]) (n = 21) |
1.6 (0.7 to 2.0) | <0.0001 |
|
CYP total (μmol/L) |
10.5 (6.7–18.0, [0.3–57]) (n = 158) |
33.5 (21.3–43.2, [7.5–89.4]) (n = 21) |
23 (15 to 27) | <0.0001 |
|
Total metabolites (μmol/L) |
587 (390–976, [27–3,862]) (n = 158) |
687 (522–1,179, [254–1,815]) (n = 21) |
99 (−47 to 321) | NS |
| % APAP‐Glu |
85 (77–89, [23–95]) (n = 158) |
87 (82–91, [58–93]) (n = 21) |
2.3 (−0.45 to 6.1) | NS |
| % APAP‐Sul |
13.2 (9.3–21.3, [2.8–67]) (n = 158) |
7.5 (5.4–11.2, [2.8–40.2]) (n = 21) |
−5.7 (−8.4 to [−2.6]) | 0.0002 |
| % CYP metabolites |
1.6 (1.3–2.4, [0.1–18.2]) (n = 158) |
4.1 (2.6–6.8, [1.1–10.3]) (n = 21) |
2.5 (1.6 to 3.7) | <0.0001 |
| Proposed risk stratification tools | ||||
| APAP‐Cys/APAP‐Sul |
0.12 (0.06–0.19, [0.0–1.4]) (n = 158) |
0.54 (0.25–0.98, [0.1–2.0]) (n = 21) |
0.43 (0.24 to 0.65) | <0.0001 |
| ALT*APAP‐Cys/APAP‐Sul |
2.0 (1.0–3.8, [0.0–68.8]) (n = 156) |
17.5 (5.8–38.7, [1.2–94.2]) (n = 21) |
15.5 (5.8 to 24.2) | <0.0001 |
| Acetaminophen ratio*APAP‐Cys |
8 (2–23, [0–1,004]) (n = 158) |
80 (36–221, [9–4,459]) (n = 21) |
72 (37 to 109) | <0.0001 |
| Acetaminophen ratio*APAP‐Cys*ALT |
156 (47–387, [0–17,059]) (n = 156) |
3,202 (807–7,582, [286–347,810]) (n = 21) |
3,046 (1,325 to 3,345) | <0.0001 |
NS, not significant.
[Correction added on 03 May 2023, after first online publication: In Table 3, the n value of third column heading ((Peak ALT ≥ 100 U/L) (median) (IQR, [range], n) (n = 21)) has been corrected in this version.]