External validation of the @entity1443 -aminotransferase multiplication product to predict hepatotoxicity from @entity1443 XXXX .

@entity1 @entity898 @entity3929 @entity1443 @entity1445
CONTEXT: Risk prediction in @entity1443 ( @entity1443 , or @entity1443 ) poisoning treated with @entity898 helps guide initial @entity1 management and disposition. The @entity1443 -aminotransferase multiplication product may be a useful and less time-sensitive risk predictor. OBJECTIVE: The aim of this study was to validate this multiplication product in an independent cohort of @entity1 with @entity1443 @entity1445 . MATERIALS AND METHODS: Using an existing toxicology dataset of poisoned @entity1 from two large inner-city United Kingdom teaching hospitals, we retrospectively identified by electronic search all @entity1443 @entity1445 from February 2005 to March 2013. We assessed the diagnostic accuracy of the multiplication product (serum @entity1443 concentration * @entity3929 transaminase [ALT] activity), especially at the pre-specified cut-off points of 1 500 mg/L * IU/L (10 000 micromol/L * IU/L) and 10 000 mg/L * IU/L (66 000 micromol/L * IU/L). The primary outcome was hepatotoxicity defined by a peak ALT > 1000 IU/L. RESULTS: Of 3823 total @entity1443 @entity1445 presentations, there were 2743 acute single, 452 delayed single (> 24 h post @entity1445 ), 426 staggered (ingestion over > 1 h), and 202 supratherapeutic ingestions. Altogether, 34 @entity1 developed hepatotoxicity. Among the acute single-ingestion @entity1 , a multiplication product > 10 000 mg/L * IU/L had a sensitivity of 80% (95% confidence interval [CI]: 44%, 96%) and specificity of 99.6% [99.3%, 99.8%], while a product > 1 500 mg/L * IU/L had a sensitivity of 100% [66%, 100%] and specificity of 92% [91%, 93%]. Overall, 16 @entity1 with a multiplication product > 10 000 mg/L * IU/L developed hepatotoxicity (likelihood ratio: 250, 95% CI: 130, 480), and 4 @entity1 with a multiplication product between 1 500 and 10 000 (likelihood ratio: 2.5, 95% CI: 1.0, 6.0). No @entity1 with a product < 1 500 mg/L * IU/L who received @entity898 developed hepatotoxicity. CONCLUSIONS: Regardless of ingestion type, a product > 10 000 mg/L * IU/L was associated with a very high likelihood, and < 1 500 mg/L * IU/L with a very low likelihood, of developing hepatotoxicity in @entity1 treated with @entity898 .
