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Title: Analysis of the Australia and New Zealand referral criteria for transfer to a liver unit for paracetamol overdose.
Austin Authors: Xu, Yifan;Testro, Adam G ;Wong, Anselm Y 
Affiliation: Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
Victorian Liver Transplant Unit
Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
Issue Date: Dec-2021
Date: 2021-05-04
Publication information: Emergency Medicine Australasia : EMA 2021; 33(6): 1021-1026
Abstract: 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. 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. 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). 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.
DOI: 10.1111/1742-6723.13795
ORCID: 0000-0002-6817-7289
Journal: Emergency Medicine Australasia : EMA
PubMed URL: 33946130
Type: Journal Article
Subjects: acetaminophen
hepatic failure
Appears in Collections:Journal articles

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