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- Title
The sequential organ failure assessment ( SOFA) score is an effective triage marker following staggered paracetamol (acetaminophen) overdose.
- Authors
Craig, D. G.; Zafar, S.; Reid, T. W. D. J.; Martin, K. G.; Davidson, J. S.; Hayes, P. C.; Simpson, K. J.
- Abstract
Background The sequential organ failure assessment ( SOFA) score is an effective triage marker following single time point paracetamol (acetaminophen) overdose, but has not been evaluated following staggered (multiple supratherapeutic doses over >8 h, resulting in cumulative dose of >4 g/day) overdoses. Aim To evaluate the prognostic accuracy of the SOFA score following staggered paracetamol overdose. Methods Time-course analysis of 50 staggered paracetamol overdoses admitted to a tertiary liver centre. Individual timed laboratory samples were correlated with corresponding clinical parameters and the daily SOFA scores were calculated. Results A total of 39/50 (78%) patients developed hepatic encephalopathy. The area under the SOFA receiver operator characteristic for death/liver transplantation was 87.4 (95% CI 73.2-95.7), 94.3 (95% CI 82.5-99.1), and 98.4 (95% CI 84.3-100.0) at 0, 24 and 48 h, respectively, postadmission. A SOFA score of <6 at tertiary care admission predicted survival with a sensitivity of 100.0% (95% CI 76.8-100.0) and specificity of 58.3% (95% CI 40.8-74.5), compared with 85.7% (95% CI 60.6-97.4) and 75.0% (95% CI 65.2-79.5) , respectively, for the modified Kings College criteria. Only 2/21 patients with an admission SOFA score <6 required renal replacement therapy or intracerebral pressure monitoring. SOFA significantly outperformed the Model for End-stage Liver Disease, but not APACHE II, at 0, 24-and 48-h following admission. Conclusions A SOFA score <6 at tertiary care admission following a staggered paracetamol overdose,is associated with a good prognosis. Both the SOFA and APACHE II scores could improve triage of high-risk staggered paracetamol overdose patients.
- Subjects
MULTIPLE organ failure; ACETAMINOPHEN; DRUG overdose; HEPATIC encephalopathy; BRAIN damage
- Publication
Alimentary Pharmacology & Therapeutics, 2012, Vol 35, Issue 12, p1408
- ISSN
0269-2813
- Publication type
Article
- DOI
10.1111/j.1365-2036.2012.05102.x