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Ireland and the UK have high rate of paracetamol-induced liver failure, study reveals

Large unexplained variations in paracetamol-induced acute liver failure that leads to liver transplant (ALFT) exist in Europe, with a 200-fold difference between the country with the highest rate, Ireland, and the country with the lowest rate, Italy.

The study, conducted at the request of the European Medicines Agency, compared patient data from France, Greece, Ireland, Italy, Netherlands, Portugal and the UK. The researchers identified patients with paracetamol–linked liver failure between 2005-2007.

Huge variations between European countries in liver transplant after overdose

Picture credit: Alamy

Six hundred cases of ALFT were identified, of which 114 involved paracetamol overdose, including 72 that were known to be intentional. Overdose represented 52% of ALFT in Ireland, UK 28%, France 18%, the Netherlands 8%, and Italy 1%. No cases were recorded in Greece. France had the highest per-person use of paracetamol but the third lowest ALFT rate. Overall, there was a six-fold higher risk in Ireland and a two-fold higher risk in the UK compared to the average of the participating countries.

The average event rate of ALFT over three years in the seven countries was one case per six million inhabitants per year, but in Ireland there was one case for every 286,000 inhabitants, in Italy one case for every 180 million.

There was one case of ALFT for 20.7 tonnes of paracetamol sold in Ireland, compared with one for 1,074 tonnes in Italy.

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