While the KCH criteria had excellent specificity, it was at the expense of sensitivity, yielding a limited ability to distinguish patients who would survive with conservative medical management versus those that would die without a liver transplant.52 The SOFA score, owing to its measures of physiologic parameters of multiple organ systems, was superior in discriminating patients who would benefit most from a liver transplant evaluation.52 Similar to any solid tumor transplant candidate, candidates for transplant treatment for APAP hepatotoxicity should undergo a thorough psychiatric evaluation and assessment to determine the level of social support needed
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Figure 1: Diurnal (daily) cortisol trend, based on a summary of 15 different research studies (Miller 2016)
The elevated NADH/NAD + ratio has been demonstrated to increase reducing equivalents to the electron transport chain, particularly complex I, where NADH is oxidized
