Development of a Scoring System to Differentiate Amiodarone-Induced Liver Injury From Alcoholic Steatohepatitis

Iván A. González, Lanisha D. Fuller, Xuefeng Zhang, David J. Papke, Lei Zhao, Dongwei Zhang, Xiaoyan Liao, Xiuli Liu, Maria I. Fiel, Xuchen Zhang

Research output: Contribution to journalArticlepeer-review


Objectives: Amiodarone-induced liver injury (AILI) is histopathologically similar to alcoholic steatohepatitis (ASH). We sought to elucidate their histologic differences and develop a scoring system to differentiate these two entities. Methods: A cohort of 17 AILI and 17 ASH cases was included in the initial study. Cases from three different institutions were included for further validation. Results: Macrovesicular steatosis was usually below 10% of the liver parenchyma in AILI. Hepatocyte ballooning degeneration was more common in ASH than in AILI. "Balloon-like"hepatocyte was more common in AILI than in ASH. Lobular neutrophilic inflammation, satellitosis, and cholestasis were more common in ASH. Mallory-Denk bodies and pericellular fibrosis in AILI were mainly located in zone 1 compared with a panacinar or zone 3 distribution in ASH. A scoring system was developed in which points were assigned to different histologic features; a total sum of less than 5 suggests AILI, more than 5 is ASH, and 5 is equivocal. This scoring system was then evaluated on a test cohort comprising 14 AILI cases, in which 13 cases were correctly assigned with a score less than 5. The sensitivity, specificity, and accuracy for diagnosing AILI in the test cohort were 92.9%, 91.7%, and 92.3%, respectively. Conclusions: This scoring system can aid pathologists to differentiate AILI from ASH.

Original languageEnglish
Pages (from-to)434-442
Number of pages9
JournalAmerican journal of clinical pathology
Issue number3
StatePublished - Mar 1 2022


  • Alcoholic steatohepatitis
  • Amiodarone
  • Drug-induced liver injury


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