Table 1.

Desired and acceptable biomarker attributes

Attribute	Desired	Acceptable
Specific for paracetamol overdose	Exclusively elevated by paracetamol-induced injury	Liver injury
Sensitivity for ruling out injury	ROC-AUC 1	AUC ≥ 0.90
Rapidly assayed	At point of care	<60 min turn around time
Feasibility of assay	Feasible in settings where resources are sparse (developing countries)	Feasible in standard clinical laboratories (developed countries)
Invasiveness / sample preparation time	Whole blood	Plasma/serum
Conserved (translational) across in vitro models, in vivo models and humans	Fully conserved between in vitro models, in vivo models and humans	Conserved between rodent models and humans
Time after overdose at which it is able to predict the onset of liver injury	4 h	8 h
Signal to noise	Single measure required to differentiate between healthy reference value and disease	Requires measurement at two time points
Quantitative relationship with disease severity	Quantitative	Qualitative
Distinguish benign and clinical relevant increase in ALT	Predicts liver failure	Predicts ALT rise
Mediator of liver injury	Has existing therapeutic intervention	Potential drug target