Risk Factors for Acetaminophen-induced Liver Injury: A Single-center Study from Japan

Purpose: Acetaminophen has been increasingly used for the treatment of cancer-related pain in Japan since the revision of the package insert on January 21, 2011. However, high-dose acetaminophen may cause liver injury. The objectives of this study were to investigate the prevalence of liver injury in patients receiving acetaminophen and to identify the risk factors. Methods: The subjects were patients who were treated with acetaminophen >= 1500 mg/d for >= 4 weeks at Ehime University Hospital between April 2011 and December 2014. Drug-induced liver injury was evaluated by alanine aminotransferase and alkaline phosphatase levels, Naranjo score, and Child-Pugh classification. Findings: A total of 287 of 562 patients were treated for 4 weeks with acetaminophen >= 1500 mg/d. Twenty of 102 patients analyzed had drug-induced liver injury. Multivariate analysis was performed with variables from the results of univariate analysis (sex, age >= 70 years, abnormal alanine aminotransferase and alkaline phosphatase levels, and serious liver disease), and age >= 70 years and serious liver disease were significant risk factors. (C) 2020 Elsevier Inc.