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Endogenous digoxin-like substance in liver failure

M I Lucena1, R J Andrade, J M Fraile

  • 1Clinical Pharmacology Service, University Hospital, School of Medicine, Malaga, Spain.

International Journal of Clinical Pharmacology and Therapeutics
|October 1, 1994
PubMed
Summary

Patients with severe liver failure often show false-positive digoxin test results due to a substance called digoxin-like immunoreactive substance (DLIS). Careful interpretation of digoxin levels is crucial in these patients.

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Area of Science:

  • Clinical Chemistry
  • Hepatology
  • Toxicology

Background:

  • Digoxin-like immunoreactive substance (DLIS) can cause interference in digoxin immunoassays.
  • Patients with liver failure may have elevated DLIS levels, potentially leading to inaccurate digoxin measurements.

Purpose of the Study:

  • To investigate the sensitivity of the EMIT Convenience Pack Digoxin immunoassay to DLIS interference in patients with varying degrees of liver disease.
  • To assess the prevalence of false-positive digoxin results in patients with liver failure.

Main Methods:

  • Serum digoxin levels were measured using EMIT Convenience Pack Digoxin immunoassay.
  • Patients included cirrhotic patients (Child-Pugh B or C), patients with chronic hepatitis, and healthy controls.
  • Patients with prior cardiac glycoside exposure were excluded.

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Main Results:

  • 73% of cirrhotic patients (22/30) exhibited false-positive digoxin results.
  • False-positive rates were lower in patients with mild liver disease (16.7%) and controls (10%).
  • Serum DLIS levels showed a negative correlation with prothrombin activity (r = -0.55, p < 0.00011).

Conclusions:

  • The EMIT Convenience Pack Digoxin immunoassay is highly susceptible to DLIS interference in patients with moderate to severe liver failure.
  • Digoxin levels in patients with significant liver dysfunction require cautious interpretation due to potential false elevations.
  • Elevated DLIS in liver failure may be linked to impaired liver function, as indicated by the correlation with prothrombin activity.