Association between adverse outcomes of hepatitis A and acetaminophen use: A population-based cohort study

Background: Acetaminophen (APAP) may cause acute liver injury with therapeutic doses in high-risk conditions such as chronic alcohol consumption or malnutrition. In acute hepatitis A (AHA), however, the safety of APAP has not been fully established. This study examined the potential association between APAP use and clinical outcomes of AHA in a nationwide and hospital-based cohort.Methods: Adult patients with AHA were identified from claims data of South Korean national healthcare insurance between 2008 and 2016 ( n = 43,500). Logistic regression models were used to compare the risk of adverse outcomes (renal replacement therapy, hepatic encephalopathy and/or brain edema, mechanical ventilation, and liver transplantation) in patients exposed to APAP against control and patients exposed to NSAIDs. A propensity score (PS)-matched hospital-based AHA cohort ( n = 146) was assessed for biochemical profiles after exposure to APAP or NSAIDs.Results: AHA patients were exposed to APAP or NSAIDs in 26.4% and 11.5% of cases, respectively. Compared to NSAID treatment, APAP exposure was associated with a higher incidence of hospitalization (98.8% vs. 92.4%; p < 0.0 0 01). APAP exposure was independently associated with increased adverse outcomes (odds ratio [OR] = 5.66, p < 0.0 0 01 against control; OR = 1.67, p = 0.0015 against NSAIDs). PSmatched hospital cohort showed higher peak serum bilirubin levels (7.0 vs. 5.3 mg/dL; p = 0.03) and a longer time to recovery of jaundice after APAP use than with NSAID use. Conclusion: APAP exposure was associated with increased adverse outcomes in a nationwide AHA cohort.(c) 2023 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.