幸存者肝脏通常快速、完全再生,1-3 周内肝功能检查恢复正常。[30]Lesna M, Watson AJ, Douglas AP, et al. Evaluation of paracetamol-induced damage in liver biopsies: acute changes and follow-up findings. Virchows Arch A Pathol Anat Histol. 1976 Jul 21;370(4):333-44.http://www.ncbi.nlm.nih.gov/pubmed/826016?tool=bestpractice.com[31]Portmann B, Talbot IC, Day DW, et al. Histopathological changes in the liver following a paracetamol overdose: correlation with clinical and biochemical parameters. J Pathol. 1975 Nov;117(3):169-81.http://www.ncbi.nlm.nih.gov/pubmed/1214189?tool=bestpractice.com[32]Baeg NJ, Bodenheimer HC Jr, Burchard K. Long-term sequellae of acetaminophen-associated fulminant hepatic failure: relevance of early histology. Am J Gastroenterol. 1988 May;83(5):569-71.http://www.ncbi.nlm.nih.gov/pubmed/3364415?tool=bestpractice.com 肾损伤很少见,通常当血清转氨酶活性达到高峰时,血清肌酐水平即开始上升。患者偶尔会发生不伴肝损伤的肾损伤。[26]Hamlyn AN, Douglas AP, James O. The spectrum of paracetamol (acetaminophen) overdose: clinical and epidemiological studies. Postgrad Med J. 1978 Jun;54(632):400-4.https://pmj.bmj.com/content/postgradmedj/54/632/400.full.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/683908?tool=bestpractice.com[27]Prescott LF, Proudfoot AT, Cregeen RJ. Paracetamol-induced acute renal failure in the absence of fulminant liver damage. Br Med J (Clin Res Ed). 1982 Feb 6;284(6313):421-2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495982/pdf/bmjcred00592-0059e.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/6800485?tool=bestpractice.com
在未经筛选且未接受特异性治疗的就诊患者中,<10% 发生肝中毒,1% 发生急性肾功能衰竭,1%-2% 死于肝功能衰竭。[22]Prescott LF, Critchley JA. The treatment of acetaminophen poisoning. Annu Rev Pharmacol Toxicol. 1983;23:87-101.http://www.ncbi.nlm.nih.gov/pubmed/6347057?tool=bestpractice.com 多项研究显示,对乙酰氨基酚累积过量或延迟就诊患者严重肝中毒的风险增加,且死亡率增高。[16]Bond GR, Hite LK. Population-based incidence and outcome of acetaminophen poisoning by type of ingestion. Acad Emerg Med. 1999 Nov;6(11):1115-20.http://www.ncbi.nlm.nih.gov/pubmed/10569383?tool=bestpractice.com[17]Makin AJ, Wendon J, Williams R. A 7-year experience of severe acetaminophen-induced hepatotoxicity (1987-1993). Gastroenterology. 1995 Dec;109(6):1907-16.http://www.ncbi.nlm.nih.gov/pubmed/7498656?tool=bestpractice.com[18]Schiødt FV, Rochling FA, Casey DL, et al. Acetaminophen toxicity in an urban county hospital. N Engl J Med. 1997 Oct 16;337(16):1112-7.https://www.nejm.org/doi/full/10.1056/NEJM199710163371602http://www.ncbi.nlm.nih.gov/pubmed/9329933?tool=bestpractice.com[64]Craig DG, Bates CM, Davidson JS, et al. Staggered overdose pattern and delay to hospital presentation are associated with adverse outcomes following paracetamol-induced hepatotoxicity. Br J Clin Pharmacol. 2012 Feb;73(2):285-94.https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2125.2011.04067.xhttp://www.ncbi.nlm.nih.gov/pubmed/22106945?tool=bestpractice.com