Cardiodepressant drugs and the high mortality rate associated with ischemic hepatitis

To show that patients are more likely to die in the event of ischemic hepatitis if they take drugs where clearance is dependent on liver blood flow and where a high dose produces myocardial depression.

The drug management was studied in a case series of 28 patients in whom ischemic hepatitis was diagnosed.

Inpatients in a major teaching hospital.

Patients were identified by an increase in circulating aspartate aminotransferase activity to greater than 1000 U/L and a clinical history of a hypotensive episode or cardiac failure.

All drug use from 12 hrs before the hypotension or onset of cardiac failure was recorded. The clinical outcome was categorized as death during the acute event (ischemic hepatitis) or recovery.

Acute mortality rate was 60.7%. Among nonsurvivors, calcium-channel antagonists and antiarrhythmic drugs were used in ten (58.8%) of 17 patients, compared with two (18.2%) of 11 survivors (chi 2 = 4.504, p less than .05).

The patient who is or has been recently receiving calcium-channel blockers and/or antiarrhythmic drugs has a poor prognosis in the event of ischemic hepatitis, with a mortality rate of 83%. Further study may show whether this mortality rate reflects the severity of the premorbid cardiovascular disease in these patients or whether the presence of these drugs renders the patients more resistant to inotropic support.