Hepatitis, rhabdomyolysis and multi-organ failure resulting from statin use

This paper was published in the British Medical Journal Case Reports 2009;2009. pii: bcr07.2008.0412

Study title and authors:
Hepatitis, rhabdomyolysis and multi-organ failure resulting from statin use.

Rajaram M.
St Helens and Knowsley Hospitals NHS Trust, Medicine-Gastro, Whiston Hospital, Warrington Prescot, L35 5DR, UK.

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/21686823

This paper reports the case of of a woman who developed hepatitis, rhabdomyolysis and multi-organ failure resulting from the use of statins.

(i) A 77-year-old female patient was admitted to hospital with malaise, anorexia and generally feeling unwell for a week.
(ii) She was taking atorvastatin 80 mg daily.
(iii) The dose of atorvastatin was increased from 40 mg to 80 mg daily approximately six months before admission.
(iv) Examination revealed she was jaundiced.
(v) Laboratory tests revealed the following abnormalities (normal levels in brackets):
Creatine kinase: 523 iu/l (25–200)
Lactate dehydrogenase: 1241 iu/l (240–525)
Total bilirubin: 284 μmol/l (2–22)
Alanine transaminase: 2314 iu/l (11–55)
γ glutamyl transferase: 132 iu/l (5–50)
Aspartate transaminase: 1269 iu/l (12–42)
Alkaline phosphatase: 438 iu/l (40–125)
Urea: 15.9 mmol/l (3.6–7.3)
Creatinine: 290μmol/l (45–110)
(vi) A diagnosis of hepatitis related to statin use with accompanying kidney failure was made.
(vii) The statin was stopped and her liver biochemistry improved.
(viii) However on the fourth day after admission, her kidney function deteriorated.
(ix) Examination revealed excess fluid around the lungs and abdominal areas.
(x) The patient was transferred to the intensive care unit and required haemofiltration. (Hemofiltration is a kidney replacement therapy similar to hemodialysis).
(xi) Despite improvement in her kidney function, the creatine kinase levels continued to rise and peaked at 107178 iu/l.
(xii) Two weeks after admission to the hospital, the patient died of multi-organ failure.

Rajaram concludes: "The cause of hepatitis, rhabdomyolysis, and acute renal failure in this patient was the increase in dose of atorvastatin and subsequent elevation of serum atorvastatin concentration. We suggest that the elevation of atorvastatin concentrations resulted in skeletal muscle damage and rhabdomyolysis, as indicated by the elevation of creatine kinase and subsequent deposition of myoglobin in the kidneys, causing acute renal failure as indicated by the elevation of urea and creatinine".

Statin use is associated with an 80% higher risk of multiple organ failure in severely injured blunt trauma patients

This study was published in the Journal of Trauma 2009 Sep;67(3):476-82; discussion 482-4

Study title and authors:
Preinjury statin use is associated with a higher risk of multiple organ failure after injury: a propensity score adjusted analysis.

Neal MD, Cushieri J, Rosengart MR, Alarcon LH, Moore EE, Maier RV, Minei JP, Billiar TR, Peitzman AB, Sperry JL
Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/19741387

This study sought to determine the relationship between preinjury statin use and outcome in severely injured blunt trauma patients. (Blunt trauma is a usually serious injury caused by a blunt object or collision with a blunt surface, as in a vehicle accident or fall from a building). Data was obtained from 295 blunt injured adults with hemorrhagic shock. Patients aged 55 years and older were analysed.

The study found preinjury statin use was associated with an 80% higher risk of multiple organ failure in severely injured blunt trauma patients.

Atorvastatin induced multiple organ failure

This paper was published in the Journal of the Louisiana State Medical Society 2010 May - Jun;162(3):159-60

Study title and authors:

Atorvastatin induced multiple organ failure.

Kandavar R, Sander GE.

Department of Internal Medicine, Tulane University School of Medicine, New Orleans, USA.

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/20666169

A 71 year old woman with a past medical history of diabetes, high blood pressure and heart disease was being treated with atorvastatin and verapamil (for blood pressure) in addition to a few other medications.

She complained of nausea, vomiting, muscle pain, generalized weakness and dark urine. An inspection revealed jaundice and mild mental confusion and features of multiple organ dysfunction. The patient died within 5 days of multiple organ failure.

Kandavar found that the cause of multiple organ failure could be the result increased blood levels of atorvastatin.