We read with great interest the article by Larson A et al. 1 regarding the characteristics and the outcome of acetaminophen-induced acute liver failure (ALF) in a large cohort of patients in the USA. Interestingly, they found that the APACHE II score performed better in terms of predicting outcome with a much higher sensitivity and slightly lower specificity, compared with the King's Hospital criteria. The accompanying editorial had a word of caution suggesting the King's criteria had not been used in the clinical context in which they had been originally derived. As prophylactic use of fresh frozen plasma in the United States was common place this would have altered the prothrombin time assessment. 2 Recently, we have evaluated 100 consecutive patients with acetaminophen-induced ALF (41 men, mean age 38 Ϯ 13 years). At admission, demographic, clinical and laboratory variables were recorded, including baseline serum phosphate and arterial blood lactate concentrations at 0, 4, 8 and 12 hours post admission. Fresh frozen plasma was not used.
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