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• W1971797073 abstract "FHF, fulminant hepatic failure; KCH, King's College Hospital. We read with interest the recent study by Chung, Sitrin, Te regarding serum phosphate (PO4) levels as a predictor of clinical outcome in fulminant hepatic failure.1 This study did not specify the timing of serum PO4 measurement and concluded better prognosis in low serum PO4 patients. A similar prospective study by Schmidt and Dalhoff2 investigated the outcome in paracetamol poisoning, which is the most common cause of acute liver failure in North America and Europe. This study concluded that a PO4 concentration of 1.2 mmol/L at 48 to 96 hours after overdose was highly specific and sensitive and had a greater overall predictive value than King's College Hospital criteria.3 We carried out a retrospective analysis in our cohort of patients with paracetamol poisoning referred to the Scottish Liver Transplant Unit during the period 1992 to 2002. Four hundred fifty-four patients were referred with paracetamol-induced hepatotoxicity within the 10- year period. We selected 117 patients with both the time from paracetamol ingestion to N-acetyl cysteine administration and at least one PO4 measurement available at 48 to 96 hours postoverdose. The median time from ingestion to hospital admission was 24 hours (range, 5–96 hours) and all patients were given intravenous N-acetyl cysteine upon arrival at the hospital. There were 58 (49.6%) spontaneous survivors who did not fulfil the KCH criteria. Fifty-nine (50.4%) patients met the KCH criteria of whom 11 were transplanted and the other 48 died without a liver transplant. Out of 117 patients, 38 patients had PO4 measurements on both day 2 (48 to 72 hours postoverdose) and day 3 (72 to 96 hours postoverdose), 36 patients had PO4 measurement available only on day 2, and 43 patients only on day 3. A corresponding serum creatinine was also recorded. Phosphate concentrations were significantly higher in nonsurvivors or transplanted patients than survivors on day 2 (1.32 ± 1.06 mmol/L vs. 0.66 ± 0.26 mmol/L, respectively; Mann-Whitney: P < 0.001) but were not significantly higher on day 3 (0.98 ± 0.81 mmol/L vs. 0.64 ± 0.38 mmol//L, respectively; Mann-Whitney: P = 0.16). The discriminant PO4 value of 1.2 mmol/L reported by Schmidt and Dalhoff was found to have a poor negative predictive value as 66.7% (22/33) of measurements on day 2 and 66.7% (34/51) of measurements on day 3 from the nonsurvivors/transplanted group were below it. There was a definite overlap in PO4 concentrations between survivors and nonsurvivors/transplanted patients as shown in Figure 1. In contrast, only four of the survivors had a PO4 more than 1.2 mmol/L. All four patients had renal failure. There was significant correlation between creatinine level and PO4 concentrations on day 2 (Spearman: R = 589, P= .01) and day 3(Spearman: R = 597, P = .01). As expected, creatinine levels were significantly higher in nonsurvivors/transplanted patients compared with the spontaneous survival group (228 ± 113 μmol/L vs. 116±87 μmol/L, respectively; Mann-Whitney: P < 0.000). Serum phosphate (PO4) levels on days 2 and 3, according to King's College Hospital (KCH) criteria. Dotted lines indicate 1.2 mmol/L. A: Day 2 post overdose. B: Day 3 post overdose. Our analysis showed serum phosphate was related to renal failure in paracetamol poisoning patients but was not useful as a predictor of outcome. At present, serum phosphate cannot be considered a reliable early predictor of outcome in paracetamol poisoning and possibly in fulminant hepatic failure. Khee Lim Ng*, J.S. Davidson*, Andrew J. Bathgate*, * Scottish Liver Transplant Unit Royal Infirmary of Edinburgh Edinburgh, Scotland." @default.
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• W1971797073 date "2004-01-01" @default.
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• W1971797073 title "Serum phosphate is not a reliable early predictor of outcome in paracetamol induced hepatotoxicity" @default.
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• W1971797073 doi "https://doi.org/10.1002/lt.20022" @default.
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