Long‐term prognosis for transplant‐free survivors of paracetamol‐induced acute liver failure

Aliment Pharmacol Ther 2010; 32: 894–900 Summary Background The prognosis for transplant‐free survivors of paracetamol‐induced acute liver failure remains unknown. Aim To examine whether paracetamol‐induced acute liver failure increases long‐term mortality. Methods We followed up all transplant‐free survivors of paracetamol‐induced acute liver injury, hospitalized in a Danish national referral centre during 1984–2004. We compared age‐specific mortality rates from 1 year post‐discharge through 2008 between those in whom the liver injury led to an acute liver failure and those in whom it did not. Results We included 641 patients. On average, age‐specific mortality rates were slightly higher for the 101 patients whose paracetamol‐induced liver injury had caused an acute liver failure (adjusted mortality rate ratio = 1.70, 95% CI 1.02–2.85), but the association was age‐dependent, and no survivors of acute liver failure died of liver disease, whereas suicides were frequent in both groups. These observations speak against long‐term effects of acute liver failure. More likely, the elevated mortality rate ratio resulted from incomplete adjustment for the greater prevalence of substance abuse among survivors of acute liver failure. Conclusions Paracetamol‐induced acute liver failure did not affect long‐term mortality. Clinical follow‐up may be justified by the cause of the liver failure, but not by the liver failure itself.