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Macrophage Migration Inhibitory Factor as a Potential Biomarker in Acetaminophen Overdose: A Pilot Study.

Introduction
Acetaminophen overdose is a leading cause of liver failure in the United States. Macrophage migration inhibitory factor (MIF) is a cytokine that is released early and promotes acetaminophen toxicity in preclinical models. This cytokine could prove a useful biomarker in emergency department (ED) patients immediately following an acute acetaminophen overdose.


Methods
We selected a convenience sample of thirteen patients from a prospective consecutive cohort of ED patients with suspected acute overdose. Research associates collected waste specimens for MIF analysis that remained after use for clinical care. Our team compared patients with confirmed acetaminophen overdose (n=9) to patients without acetaminophen exposure or liver injury (n=3) and a patient with liver injury in the absence of detectable acetaminophen (n=1).


Results
In our acetaminophen group, all nine patients had measurable acetaminophen concentrations. Median MIF serum concentrations were 16.08 ng/mL (IQR 2.06, 91.40) in the overdose group compared with the control group serum concentrations of 0.19 ng/mL (IQR 0.05, 0.32) (p = 0.0091).


Conclusion
In this pilot study, MIF was feasible to measure in specimens from an ED drug overdose cohort, and was significantly elevated in the acetaminophen group compared to non-acetaminophen controls without liver injury.