APAP, Non-APAP Induced Acute Liver Failure More Likely in Women
BOSTON, MA—Women were more likely to present with acetaminophen (APAP) and non-APAP drug-induced acute liver failure compared to men, according to a poster presentation at The Liver Meeting® 2016.
Gender differences have been established for most chronic liver diseases but less is known with acute liver failure. Women with APAP acute liver failure tend to have higher-grade encephalopathy and require more critical care than their male counterparts. "It is unknown whether these differences apply to non-APAP drug-induced acute liver failure," stated Jessica Rubin, MD, from University of California San Francisco, San Francisco, CA.
The study authors conducted a retrospective study to investigate sex differences in the natural history of APAP and non-APAP acute liver failure among patients enrolled in the Acute Liver Failure Study Group (ALFSG) group between January 2000–July 2015.
Females comprised most of the APAP acute liver failure (n=864) and non-APAP acute liver failure groups (n=211). Both men and women with non-APAP acute liver failure were of similar age; women in the APAP acute liver failure group were older than their male counterparts. Acute liver failure was defined as encephalopathy, INR >1.5, and illness lasting <26 weeks. Dr. Rubin and coauthors aimed to measure presentation and hospital course as well as 21-day overall survival and transplant-free survival.
"On presentation, men with APAP acute liver failure had worse lab parameters than women, including significantly higher median ALT, creatinine, and MELD scores," noted Dr. Rubin. Creatinine was the only parameter higher in men (1.4 vs. 1.1; P<0.01) in patients with non-APAP acute liver failure. Overall, APAP acute liver failure was more common in female vs. male patients (76% vs. 24%). Similarly, non-APAP acute liver failure was more common in female vs. male patients (65% vs. 35%).
Women with APAP acute liver failure were more likely to present with severe encephalopathy on admission vs. men (59% vs. 42%; P<0.01) but presence was similar between men and women with non-APAP acute liver failure (33% vs. 24%; P=0.18).
Compared to their male counterparts, women with APAP acute liver failure were more likely to require intubation (P<0.01), vasopressors (P=0.05), and mannitol (P=0.01) whereas men and women with non-APAP acute liver failure exhibited similar critical care needs. Dr. Rubin further added there were no differences in survival at 21 days between men and women in either acute liver failure group.
The findings suggest a higher degree of sensitivity to hepatotoxicity or more frequent use of hepatotoxic agents among female patients. Study authors encourage further analysis of sex differences in drug use and metabolism to understand the critical care needs in patients with APAP drug-induced acute liver failure.