The risk factors of death from the acetaminophen poisoning with antipyretic-analgesic drugs in Japan.

Since adverse effects rarely occur with the therapeutic doses of acetaminophen, it is commonly used as a mild antipyletic and analgesic. However, overdosage of acetaminophen causes fatal hepatic failure and acute renal failure. Therefore, we evaluated the risk factors for death among the reported cases of acetaminophen poisoning in Japan, which were obtained from Japan Science and Technology Corporation, Information Center for Science and Technology (JICST) on-line service in the Kyushu University Library. In a univariate analysis, the death rate of patients with hepatic failure (23.3% vs 0%, p = 0.04), disseminated intravascular coagulation syndrome (DIC) (38.1% vs 5.3%, p = 0.001) or plasma exchange treatment (33.3% vs 7.9%, p = 0.01) was significantly greater than those without it while a multivariate analysis revealed that DIC (with vs without; odds ratio = 23.04, 95% confidence interval = 2.80-189.75) and the treatment with plasma exchange (with vs without; odds ratio = 14.77, 95% confidence interval = 1.44-151.52) were independent risk factors. These results suggest that DIC and hepatic failure, especially requiring plasma exchange, were poor prognostic factors. In addition, about seventeen percent of the cases with less than 5 g of acetaminophen ingestion were death cases although the acute lethal adult dose is shown 13-25 g in western countries. This suggests that its acute lethal dose may be low in Japan, which may be partly due to the additional adverse effect of other drugs used in the mixed compounds while acetaminophen alone is used in western countries. An intensive treatment should be recommended for the acetaminophen poisoning patients regardless of the ingested dose.