What Every Intensivist should Know about Impairment of Cardiac Function and Arrhythmias in Liver Disease Patients: A Review

Arya, Sanjeev; Kumar, Pankaj; Tiwari, Bhuwan Chandra; Belwal, Shantanu; Saxena, SK; Abbas, Haider

doi:10.5005/jp-journals-10071-23695

Cited by 6 publications

(7 citation statements)

References 53 publications

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“…Cluster B is of great interest and would require more specific studies, as it groups hepatocellular damage, long QT syndrome, and myopathy. This pattern of co-reported events could be related to QT interval prolongation in severe liver damage ( Arya et al, 2020 ), but also to reduced clearance and frequent combination of three drugs disproportionally associated with the cluster and known to induce long-QT and liver injury ( Roy and Mukhopadhyay, 2020 ): of the 3,487 reports with at least one of them, 1,042 (29.9%) reported both hydroxychloroquine and azithromycin, 361 (10.4%) both lopinavir/ritonavir and hydroxychloroquine, 64 (1.8%) both lopinavir/ritonavir and azithromycin, 315 all three drugs (9.0%). These clusters are thus presumably attributable to drugs.…”

Section: Discussionmentioning

confidence: 94%

Development of a Network-Based Signal Detection Tool: The COVID-19 Adversome in the FDA Adverse Event Reporting System

et al. 2021

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Introduction: The analysis of pharmacovigilance databases is crucial for the safety profiling of new and repurposed drugs, especially in the COVID-19 era. Traditional pharmacovigilance analyses–based on disproportionality approaches–cannot usually account for the complexity of spontaneous reports often with multiple concomitant drugs and events. We propose a network-based approach on co-reported events to help assessing disproportionalities and to effectively and timely identify disease-, comorbidity- and drug-related syndromes, especially in a rapidly changing low-resources environment such as that of COVID-19.Materials and Methods: Reports on medications administered for COVID-19 were extracted from the FDA Adverse Event Reporting System quarterly data (January–September 2020) and queried for disproportionalities (Reporting Odds Ratio corrected for multiple comparisons). A network (the Adversome) was estimated considering events as nodes and conditional co-reporting as links. Communities of significantly co-reported events were identified. All data and scripts employed are available in a public repository.Results: Among the 7,082 COVID-19 reports extracted, the seven most frequently suspected drugs (remdesivir, hydroxychloroquine, azithromycin, tocilizumab, lopinavir/ritonavir, sarilumab, and ethanol) have shown disproportionalities with 54 events. Of interest, myasthenia gravis with hydroxychloroquine, and cerebrovascular vein thrombosis with azithromycin. Automatic clustering identified 13 communities, including a methanol-related neurotoxicity associated with alcohol-based hand-sanitizers and a long QT/hepatotoxicity cluster associated with azithromycin, hydroxychloroquine and lopinavir-ritonavir interactions.Conclusion: Findings from the Adversome detect plausible new signals and iatrogenic syndromes. Our network approach complements traditional pharmacovigilance analyses, and may represent a more effective signal detection technique to guide clinical recommendations by regulators and specific follow-up confirmatory studies.

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Section: Discussionmentioning

confidence: 94%

Development of a Network-Based Signal Detection Tool: The COVID-19 Adversome in the FDA Adverse Event Reporting System

et al. 2021

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“…In our study, the mean Bilirubin level after treatment with Remdesivir reached 13.17 μ mol/L in the group with cardiac complications. Although Bilirubin and ALKP have been linked to cardiovascular outcomes [36,37], their true prognostic role remains unclear, as they may be cardiac disease markers.…”

Section: Discussionmentioning

confidence: 99%

Remdesivir-Related Cardiac Adverse Effects in COVID-19 Patients: A Case-Control Study

Abedipour,

Mirzaei,

Ansari

et al. 2024

Drug Res (Stuttg)

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Background There have been reports of serious side effects of Remdesivir, including cardiovascular complications. The present study aimed to determine the adverse cardiovascular effects of Remdesivir and the factors affecting them in COVID-19 patients. Methods The patients were classified into two groups: those receiving Remdesivir without cardiac complications and those receiving Remdesivir with cardiovascular complications. After reviewing the patientʼs medical records, the relationship of some factors with the incidence of adverse cardiovascular effects was measured. Results Chi-square test showed that the distribution of complications in men was significantly higher than in women (P=0.001). The independent t-test revealed that the mean age in the group with complications was significantly higher than the group without complications (P=0.013). Fisherʼs exact test demonstrated a significant relationship between smoking and cardiovascular complications (P=0.05). According to the Mann-Whitney test, a significant difference was found in the mean changes of Bilirubin (P=0.02) and ALKP (P=0.01) before and after treatment in the groups with and without heart complications. Conclusion Our findings indicated that most of the COVID-19 patients suffered from sinus bradycardia, and the distribution of complications was more pronounced in men than in women. The mean age in the group with complications was higher than the group without complications. Smoking was found to be associated with the occurrence of cardiovascular complications and the mean changes of Bilirubin and ALKP before and after treatment were significantly different in the groups with and without cardiovascular complications.

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“…A study involving 56 non-moderate chronic drinkers with liver cirrhosis or early cirrhosis showed a strong positive relationship between the coexistence of chronic liver disease and cardiomyopathy among the recruits [20]. A review paper stated that approximately 50% of liver cirrhosis cases developed cirrhotic cardiomyopathy, regardless of the etiologies [21]. Nonetheless, despite the efforts to correlate cardiovascular findings to chronic liver disease, controversies still exist [22].…”

Section: Discussionmentioning

confidence: 99%

Alcoholic cardiomyopathy in patients with alcoholic liver cirrhosis: a study across 10 years

Wang

Gao

Liu

et al. 2023

European Journal of Gastroenterology &Amp; Hepatology

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Background and objectives Available data regarding cardiomyopathy in patients with alcoholic liver cirrhosis (ALC) are very limited because it often requires multidisciplinary assessments. The study aims to evaluate the prevalence of alcoholic cardiomyopathy in ALC and their clinical correlations. Methods Adult ALC patients without a previous diagnosis of cardiovascular diseases between January 2010 and December 2019 were included in the study. The prevalence rate of alcoholic cardiomyopathy in patients with ALC was calculated together with a 95% confidence interval (CI) using the Clopper–Pearson exact method. Results A total of 1022 ALC patients were included. Male patients predominated (90.5%). ECG abnormalities were observed in 353 patients (34.5%). Prolonged QT interval was most common in ALC patients with ECG abnormalities, which occurred in 109. Thirty-five ALC patients underwent the cardiac MRI examination and only one patient was found with cardiomyopathy. The estimated prevalence rate of alcoholic cardiomyopathy in all the ALC patients was 0.0286 (95% CI, 0.0007–0.1492). There was no statistical difference regarding the prevalence rate between the group of patients with ECG abnormalities and the group without ECG abnormalities (0.0400 vs. 0.0000, P = 1.000). Conclusion Although ECG abnormalities, especially QT prolongation, existed in a proportion of ALC patients, cardiomyopathy in the patient population was not common. Further larger-sample studies based on cardiac MRI are needed to verify our results.

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What Every Intensivist should Know about Impairment of Cardiac Function and Arrhythmias in Liver Disease Patients: A Review

Cited by 6 publications

References 53 publications

Development of a Network-Based Signal Detection Tool: The COVID-19 Adversome in the FDA Adverse Event Reporting System

Development of a Network-Based Signal Detection Tool: The COVID-19 Adversome in the FDA Adverse Event Reporting System

Remdesivir-Related Cardiac Adverse Effects in COVID-19 Patients: A Case-Control Study

Alcoholic cardiomyopathy in patients with alcoholic liver cirrhosis: a study across 10 years

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