Over-the-counter analgesics in cirrhotic patients: a case-control study examining the risk of hospitalization for liver-associated events

Abstract

Objective. To assess the association between over-the-counter analgesic (OTCA) use and hospitalization for liver-associated events in cirrhotic patients. Material and methods. Ninety adult cirrhotics admitted with liver-associated events and 126 non-hospitalized cirrhotic controls were enrolled prospectively into a case-control study. Standardized questionnaires were used to obtain predictor variables, including detailed 30-day OTCA use. Data were analyzed via logistic regression. Results. Hepatitis C (43%), alcohol (34%), and cryptogenic (13%) were the most common etiologies of cirrhosis. OTCA use was similar between cases and controls in the 30 days prior to enrollment (34% vs. 44%; odds ratio, OR = 0.66, 95% confidence interval, CI = 0.37–1.16, p = 0.148). Adjusted analyses also found no significant association between OTCA use and hospitalization for liver-associated events (OR = 0.73, 95% CI = 0.38–1.38, p = 0.330). Furosemide (p = 0.001), lactulose (p = 0.026), and number of prior liver-associated events (p = 0.002) were positively associated with hospitalization, while propranolol showed an inverse association (p = 0.008). Conclusion. Our data suggest that non-excessive OTCA use is not significantly associated with hospitalization for liver-associated events.

Key Words::

• Acetaminophen
• anti-inflammatory agents
• non-steroidal
• fibrosis
• hospitalization
• toxicity

Acknowledgements

The authors wish to thank Kimberly Campbell, MD, Glenda Wrenn Davis, MD, Andra Greenberg, MD, Kristin King, Deborah Moretti, RN, Mina Oh, MD, and Mahesh Swaminathan, MD for their help recruiting and interviewing patients for this study.

Declaration of interest: This study was supported by an unrestricted research grant from the Commonwealth of Pennsylvania. This funding source had no influence on the design or implementation of the study; the collection, management or analysis of data; or the preparation, review or approval of the manuscript. No authors report any conflicts of interest.