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The impact of current tobacco use on the outcome of paracetamol poisoning
Author(s) -
Schmidt L. E.,
Dalhoff K.
Publication year - 2003
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.2003.01789.x
Subject(s) - medicine , outcome (game theory) , current (fluid) , tobacco use , environmental health , intensive care medicine , emergency medicine , medical emergency , population , mathematics , electrical engineering , mathematical economics , engineering
Summary Background : Tobacco smoke contains a number of substances that are capable of inducing cytochrome P450. Consequently, current tobacco use may enhance the hepatotoxicity from a paracetamol overdose by increasing the oxidative metabolism of paracetamol. Aim : To evaluate, by multivariate analysis, the effect of current tobacco use on the morbidity and mortality from paracetamol‐induced hepatotoxicity. Methods : A retrospective study was carried out on the basis of the hospital charts of 602 patients admitted with single‐dose paracetamol poisoning for whom information on current tobacco use was available. Results : In patients admitted with paracetamol poisoning, the rate of current daily tobacco use of 70% (424 of 602 patients) was considerably higher than the rate of 31% in the background population (chi‐squared test: P < 0.0001). Current tobacco use was an independent risk factor for the development of hepatic encephalopathy (odds ratio, 2.68; 95% confidence interval, 1.28–5.62) and mortality (odds ratio, 3.64; 95% confidence interval, 1.23–10.75). Current tobacco use was independently associated with high peak values of alanine transaminase and the international normalized ratio. Conclusions : Current tobacco use was very frequent in patients admitted with paracetamol poisoning. It was an independent risk factor of severe hepatotoxicity, acute liver failure and death following paracetamol overdose.