ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2018
Acetaminophen-induced Acute Liver Failure Is More Common and More Severe in Women.
Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
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Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it, 70 citations in OpenAlex.
- Liver support systems for adults with acute liver failure.The Cochrane database of systematic reviews · 2026Pooled it
- Silibinin promotes hepatocyte proliferation through PINK1/Parkin-mediated mitophagy to alleviate acetaminophen-induced liver injury.Clinical and experimental medicine · 2026Article
- Redesigning medicine: integrating sex and gender for better health outcomes.Naunyn-Schmiedeberg's archives of pharmacology · 2026Review
- Acetaminophen toxicity: Patterns of liver injury, effects on hospital length of stay, and the need for inpatient psychiatric care.Hepatology forum · 2026Article
- Underlying mechanisms and treatment of acetaminophen‑induced liver injury (Review).Molecular medicine reports · 2025Review
- Bifidobacterium bifidum reduces oxidative stress and alters gut flora to mitigate acute liver injury caused by N-acetyl-p-aminophenol.BMC microbiology · 2025Article
- Trends in Liver Transplantation for Acute Liver Failure in a Spanish Multicenter Cohort.Transplant international : official journal of the European Society for Organ Transplantation · 2025Article
- The oral administration ofmSphere · 2024Article
- Increase in Rate of Hospitalizations for Pediatric Intentional Acetaminophen Ingestion at a Single Center During the COVID-19 Pandemic.Clinical pediatrics · 2023Article
- Statistical methods for exploring spontaneous adverse event reporting databases for drug-host factor interactions.BMC medical research methodology · 2023Article
- Hepatoprotective Effect of Dried Red Jujube Fruit Extract Against Acetaminophen-Induced Acute Hepatotoxicity.Cureus · 2023Article
- Metabolomic Evaluation of N-Acetyl-p-Benzoquinone Imine Protein Adduct Formation with Therapeutic Acetaminophen Administration: Sex-based Physiologic Differences.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2022Article
- Ten simple rules in biomedical engineering to improve healthcare equity.PLoS computational biology · 2022Article
- Unraveling the effect of intra- and intercellular processes on acetaminophen-induced liver injury.NPJ systems biology and applications · 2022Article
- Probiotics: Evolving as a Potential Therapeutic Option against Acetaminophen-Induced Hepatotoxicity.Biomedicines · 2022Review
- Exogenous phosphatidic acid reduces acetaminophen-induced liver injury in mice by activating hepatic interleukin-6 signaling through inter-organ crosstalk.Acta pharmaceutica Sinica. B · 2021Article
- Plasma procalcitonin may be an early predictor of liver injury in acetaminophen poisoning: A prospective cohort study.United European gastroenterology journal · 2021Observational
- Hepatoprotective effect ofToxicological research · 2021Article
- Mitochondrial protein adduct and superoxide generation are prerequisites for early activation of c-jun N-terminal kinase within the cytosol after an acetaminophen overdose in mice.Toxicology letters · 2021Article
- Sex disparities in waitlisting and liver transplant for acute liver failure.JHEP reports : innovation in hepatology · 2021Article
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
BACKGROUND &
aimsAcetaminophen overdose is the leading cause of acute liver injury (ALI) and acute liver failure (ALF) in the developed world. Sex differences in acetaminophen-induced hepatotoxicity have not been described.
methodsWe collected data from the Acute Liver Failure Study Group cohort, a national registry of 32 academic medical centers in North America of adults with ALI or ALF, including 1162 patients with acetaminophen-induced ALI (n = 250) or acetaminophen-induced ALF (n = 912) from January 2000 through September 2016. We analyzed data on patient presentation, disease course, demographics, medical and psychiatric history, medication use, substance use, and details of acetaminophen ingestion. Sex differences in continuous and categorical variables were evaluated by Wilcoxon rank-sum and χ
resultsMost patients with acetaminophen-induced ALI (68%) or ALF (76%) were women. Higher proportions of women than men had psychiatric disease (60% of women vs 48% of men, P < .01) and had co-ingestion with sedating agents (70% of women vs 52% of men, P < .01)-more than half of which were opioids. Higher proportions of women had severe hepatic encephalopathy (HE) (68% of women vs 58% of men), and required intubation (67% of women vs 59% of men, P values <.03). Higher proportions of women used vasopressors (26% of women vs 19% of men, P = .04) or mannitol (13% of women vs 6% of men, P < .01); proportions of male vs female patients with transplant-free survival were similar (68%). On adjusted analysis, women had higher risk of severe HE (adjusted odds ratio [AOR], 1.66; 95% CI, 1.17-2.35). We found a significant interaction between sex and co-ingestion of sedating agents (P < .01); co-ingestion increased odds of severe HE in women 2-fold (AOR, 1.86; 95% CI, 1.28-2.69; P < .01) but not in men (AOR; 0.62; 95% CI, 0.34-1.13; P = .12).
conclusionsIn an analysis of the Acute Liver Failure Study Group cohort, we found acetaminophen-induced ALI and ALF to be more common among women. Women have greater critical care needs than men, and increased risk for severe HE, which could be due in part to increased use of sedatives. Future studies should investigate sex differences in acetaminophen metabolism and hepatotoxicity, particularly among users of opioids.
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