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Falsely elevated digoxin concentrations in patients with liver disease.

B Rosenkranz, J C Frölich

    Therapeutic Drug Monitoring
    |January 1, 1985
    PubMed
    Summary

    Patients with liver disease may experience false-positive digoxin test results due to interfering substances in their blood. This interference is more pronounced in patients with co-existing kidney disease, impacting cardiac glycoside testing accuracy.

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    Area of Science:

    • Clinical Chemistry
    • Toxicology
    • Internal Medicine

    Background:

    • Accurate measurement of digoxin levels is crucial for therapeutic drug monitoring in patients with cardiac conditions.
    • Radioimmunoassay (RIA) is a common method for quantifying digoxin, but it can be susceptible to interference from endogenous or exogenous substances.
    • Liver disease can alter drug metabolism and protein binding, potentially affecting immunoassay results.

    Purpose of the Study:

    • To investigate the presence of immunoreactive digoxin in patients with liver disease who were not taking cardiac glycosides.
    • To identify potential interfering substances in the blood of liver disease patients that could affect digoxin immunoassay results.
    • To assess the impact of concomitant renal disease on these assay results.

    Main Methods:

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    • Blood samples were collected from 73 patients diagnosed with various forms of liver disease.
    • Patients included in the study were not on any cardiac glycoside medication.
    • Immunoreactive digoxin levels were determined using a radioimmunoassay (RIA) method. Renal function was also assessed.

    Main Results:

    • Seventeen out of 73 patients (approximately 23%) exhibited reproducible false-positive digoxin results, with levels up to 3.6 ng/ml.
    • Patients with concurrent renal disease showed significantly higher mean assay results (1.9 ng/ml) compared to those with normal renal function (0.6 ng/ml).
    • These findings suggest the presence of an interfering substance in the blood of a subset of liver disease patients.

    Conclusions:

    • The blood of patients with liver disease, particularly those with co-existing renal impairment, may contain substances that interfere with digoxin radioimmunoassay.
    • This interference can lead to false-positive digoxin results, potentially complicating clinical management and therapeutic drug monitoring.
    • Further research is warranted to identify the specific interfering substance(s) and develop methods to mitigate this assay interference.