Acetaminophen Post Bariatric Surgery Ups Liver Failure Risk

Article excerpt

AT THE ANNUAL MEETING OF THE AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES

BOSTON--Prior bariatric surgery appears to be an independent risk factor for acetaminophen-related acute liver failure or injury according to researchers.

A retrospective study of patients with acute liver failure (ALF) showed that 9 of 54 (17%) patients with ALF attributed to acetaminophen (APAP-ALF) had previously had bariatric surgery compared with none of 47 patients with ALF from other causes, Dr. Edward W. Holt, a researcher at California Pacific Medical Center, San Francisco, said at the meeting.

Although previous studies have shown associations between bariatric surgery and between alcohol abuse and APAP-ALF, they found that there were no significant differences in rates of suicidal ideation, depression, or alcohol abuse between patients who underwent bariatric surgery and those who had not, suggesting that bariatric surgery itself was a risk factor, Dr. Holt said.

"If validated in a larger cohort, our novel finding may identify a new group of patients at higher risk for APAP-ALF. If validated, additional warnings for patients with prior bariatric surgery may be warranted, similar to those currently in place for patients who consume three or more alcoholic drinks daily."

Explanations for the association include higher peak serum concentrations of ethanol after a challenge in patients who have undergone bariatric surgery as well as higher rates of suicidal behaviors among these patients, compared with controls.

Dr. Holt and his colleagues retrospectively reviewed data from their center on a prospectively identified cohort of 101 patients with acute liver failure from acetaminophen and other causes, including drug-induced, infections, lymphoma, is-chemia, and heatstroke. Of the 54 patients with APAP-ALF, 8 had undergone roux-en-Y gastric bypass, and one had a duodenal switch procedure, at a mean of nearly 6 years before diagnosis of ALF.

Among the patients in the APAP-ALF group, the prevalence of bariatric surgery was 25.3-fold higher than the estimated prevalence in the general population (16. …