Amiodarone-Induced Cirrhosis of Liver: What Predicts Mortality?

Abstract

Introduction. Amiodarone has been used for more than 5 decades for the treatment of various tachyarrhythmias and previously for the treatment of refractory angina. There are multiple well-established side effects of amiodarone. However, amiodarone-induced cirrhosis (AIC) of liver is an underrecognized complication. Methods. A systematic search of Medline from January 1970 to November 2012 by using the following terms, amiodarone and cirrhosis, identified 37 reported cases of which 30 were used in this analysis. Patients were divided into 2 subsets, survivors versus nonsurvivors, at 5 months. Results. Aspartate aminotransferase was significantly lower (P = 0.03) in patients who survived at 5-months (mean 103.33 IU/L) compared to nonsurvivors (mean 216.88 IU/L). There was no statistical difference in the levels of prothrombin time, total bilirubin, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, cumulative dose, and latency period between the two groups. The prevalence of DM, HTN, HLD, CAD, and CHF was similar in the two groups. None of the above-mentioned variables could be identified as a predictor of survival at 5 months. Conclusion. AIC carries a mortality risk of 60% at 5 months once the diagnosis is established. Further prospective studies are needed to identify predictors of AIC and of mortality or survival in cases of AIC.

A Case of Amiodarone-induced Hepatitis and Review of the Literature

“…Serum enzyme elevations are reported to occur in 15% to 50% of patients on long term therapy. However, with lower doses (200 mg to 300 mg daily), ALT elevations are less common [4]. Also, pre-existing liver dysfunction was not predictive of transaminitis in a population of 720 Chinese patients.…”

“…In a 2013 study by Hassain et al a MEDLINE search from 1970 to 2012 found only 37 reported cases of amiodarone associated with cirrhosis [4]. They also revealed that Aspartate aminotransferase was significantly lower (P = 0.03) in patients who survived at 5-months (mean 103.33 IU/L) compared to non-survivors (mean 216.88 IU/L) and demonstrated that amiodarone associated cirrhosis carried a mortality risk of 60% at 5 months once the diagnosis was established [4].…”

Iodine accumulation of the liver in patients treated with amiodarone can be unmasked using material decomposition from multiphase spectral-detector CT

“…In the group of amiodarone patients, VNC led to a mean decrease of LAI of around 10 HU compared to TNC, potentially representing artificially high attenuation in TNC from the iodine in amiodarone. This difference can be relevant in amiodarone patients when it obscures potential liver damage reflected by liver steatosis 1,7,8 . The LAI is predictive for a liver fat fraction of >30% and image-based diagnosis of liver steatosis when the difference is less than −10 HU 39-41 , hence a mean difference of 10 HU could possibly lead to many misclassified patients.…”

“…Amiodarone concentrations in the liver can be up to 500-times higher than in the blood serum and release from hepatocytes is slow after treatment discontinuation 1-6 . Earlier studies found that this condition can lead to steatohepatitis and liver cirrhosis 1,7,8 .…”

“…Amiodarone concentrations in the liver can be up to 500-times higher than in the blood serum and release from hepatocytes is slow after treatment discontinuation 1-6 . Earlier studies found that this condition can lead to steatohepatitis and liver cirrhosis 1,7,8 .Iodinated contrast media is broadly applied in CT imaging. Due to its high physical density and k-edge effects of iodine, it increases attenuation and image contrast that improves depiction of anatomical structures (e.g.…”