US Poison Center Reports of Liver Injury Jumped Nearly 400% Over 24 Years, Study Finds

Reports to US poison centers involving liver damage from medications, supplements, alcohol and other substances rose nearly 400% between 2000 and 2024, according to a study led by Christopher P. Holstege of UVA Health. The researchers examined liver injuries caused by "xenobiotics," substances foreign to the body, including medications, food additives, alcohol and environmental pollutants, identifying 220,160 such cases over the 24 years studied, with more than 80% severe enough to require inpatient care.

After adjusting for population size, the exposure rate climbed from 10.9 cases per million people to 52.9 per million. Medications accounted for most cases, with acetaminophen implicated most often. One notable shift followed action by the US Food and Drug Administration to limit how much acetaminophen could be included in combination prescription medicines: exposures involving those combination products fell by 60% to 85% afterward, even as exposures involving acetaminophen alone continued to rise throughout the 24 years.

Women had higher rates of acetaminophen-associated liver injury than men, and suspected suicide was the most common reason for exposure in both sexes. Alcohol ranked a distant second among the leading causes of reported liver injury, occurring more often in men, though injuries involving alcohol increased in both sexes during the COVID-19 pandemic. The researchers also recorded rising, though far less common, numbers of liver injuries involving stimulants and street drugs, herbal and dietary supplements, and environmental toxins.

"Xenobiotic-induced liver injuries reported to US poison centers have steadily increased," said Holstege, director of UVA Health's Blue Ridge Poison Center. "The public should be aware of potential liver injury with various substances that are readily available to consumers... Medications should always be taken as directed by clinicians and per pharmaceutical label instructions. Care must also be taken in consuming emerging substances that are unregulated."