Amiodarone induced liver disease (AILD) is rare and resembles alcoholic steatohepatitis. Gonzalez et al reported a score for distinguishing between the two conditions. The authors are from Yale New Haven Hospital.
Patient selection: patient receiving amiodarone with liver biopsy showing steatohepatitis
Parameters:
(1) AST to ALT ratio
(2) serum total bilirubin in mg/dL
(3) ductular reaction
(4) cholestasis
(5) percentage of macrovesicular steatosis
(6) hepatocyte ballooning
(7) hepatocyte ballooning degeneration
(8) foci of lobular inflammation per 20x field
(9) predominant cell of lobular inflammation
(10) satellitosis
(11) Mallory hyaline location
(12) megamitochrondria
(13) sinusoidal Kupffer cell lipidosis
(14) pericellular fibrosis
|
Parameter |
Finding |
Points |
|
AST to ALT ratio |
< 2 |
0 |
|
|
2 to 3 |
1 |
|
|
> 3 |
2 |
|
serum total bilirubin |
< 2.5 mg/dL |
0 |
|
|
2.5 to 7 mg/dL |
1 |
|
|
> 7 mg/dL |
2 |
|
ductular reaction |
no |
0 |
|
|
yes |
1 |
|
cholestasis |
no |
0 |
|
|
yes |
1 |
|
macrovesicular steatosis |
< 10% |
0 |
|
|
10 to 33% |
1 |
|
|
> 33% |
2 |
|
hepatocyte ballooning |
no |
0 |
|
|
rare |
-1 |
|
|
abundant |
-2 |
|
hepatocyte ballooning degeneration |
no |
0 |
|
|
rare |
1 |
|
|
abundant |
2 |
|
lobular inflammation |
< 2 foci per 20x field |
0 |
|
|
2 to 4 foci per 20x field |
1 |
|
|
> 4 foci per 20x field |
2 |
|
predominant cell in lobular inflammation |
lymphocyte |
0 |
|
|
neutrophil |
1 |
|
satellitosis |
no |
0 |
|
|
yes |
1 |
|
Mallory hyaline location |
Zone 1 |
0 |
|
|
other |
1 |
|
megamitochondria |
no |
0 |
|
|
yes |
1 |
|
sinusoidal Kupffer cell lipidosis |
no |
0 |
|
|
yes |
-1 |
|
pericellular fibrosis |
absent |
0 |
|
|
zone 1 |
1 |
|
|
non-zonal |
2 |
total score =
= SUM(points for all parameters)
Interpretation:
• minimum score: -3
• maximum score: 18
|
Total Score |
Diagnosis |
|
< 10 |
amiodarone induced |
|
10 |
indeterminate |
|
> 10 |
alcoholic |
Specialty: Gastroenterology
