Details

Autor(en) / Beteiligte

• CRAIG, D. G. N.
• FORD, A. C.
• HAYES, P. C.
• SIMPSON, K. J.

Titel

Systematic review: prognostic tests of paracetamol‐induced acute liver failure

Ist Teil von

• Alimentary pharmacology & therapeutics, 2010-05, Vol.31 (10), p.1064-1076

Ort / Verlag

Oxford, UK: Blackwell Publishing Ltd

Erscheinungsjahr

2010

Quelle

MEDLINE

Beschreibungen/Notizen

• Aliment Pharmacol Ther 31, 1064–1076 Summary Background  Paracetamol (acetaminophen) toxicity remains the leading cause of acute liver failure (ALF) in the developed world. In the UK, the recently modified King’s College Criteria are used to list patients for emergency liver transplantation, but these criteria have been criticized for their low sensitivity and for spectrum bias in their application. Aim  To evaluate existing prognostic criteria critically for predicting death without transplantation in paracetamol‐induced ALF. Methods  MEDLINE, EMBASE and CINAHL were searched to identify studies containing adult patients with paracetamol‐induced ALF. Selected studies were evaluated and data were pooled if appropriate, to calculate sensitivity, specificity and diagnostic odds ratios (DORs) of applied prognostic tests. Results  Of 6507 studies identified, 14 were eligible for inclusion, evaluating 1960 patients. The original King’s College Criteria had a pooled sensitivity of 58.2% and specificity of 94.6%, with a DOR of 27.7. Addition of arterial lactate to the King’s College Criteria reduced the DOR to 26.1. Several other clinical and laboratory variables had higher DORs than the King’s College Criteria, but were only evaluated in single studies of limited quality. Conclusions  The original King’s College Criteria remain well‐validated criteria with high prognostic accuracy. Other potential prognostic variables should be prospectively assessed in multicentre studies to refine the criteria further.