Early diagnostic test for acute fatty liver of pregnancy: a retrospective case control study

Abstract

Background: Early diagnosis is important to lower the mortality rate of acute fatty liver of pregnancy (AFLP). The Swansea criteria is commonly used to diagnose AFLP, but some terms could only be reached when symptoms and signs have progressed, or are not efficient in clinical practice. Therefore, it is necessary to select cost effective tests to simplify and facilitate early suspicion of acute fatty liver of pregnancy. Methods: This is a retrospective study of 28,800 medical records at the Second Xiangya Hospital from 2009 to 2015, including 41 patients with AFLP and 172 other diseases that could show similar symptoms to AFLP. The evaluated variables included past history of liver diseases, blood pressure, gastrointestinal symptoms, blood count, liver function test, coagulation function test and blood sugar test. The sensitivity, specificity, positive predict value and negative predict value were calculated for models in diagnosing AFLP. Results: The significant variables associated with AFLP included gastrointestinal symptoms, blood pressure > 140/ 90 mmHg, aminotransferase> 42 IU/l, total bilirubin> 0.8 mg/dl, total bilirubin acid> 10.0 μmol/L, activated partial prothrombin time(APTT) > 34 s, prothrombin time(PT) > 14 s, white blood cells> 11 *10 6 /l and blood sugar< 72 mg/ dl. Gastrointestinal symptoms +aminotransferase +bilirubin +bile acid +APTT/PT showed 97.6% sensitivity and 97.1% specificity to diagnose AFLP. Adding blood pressure, blood sugar or white blood cells decreased the accuracy of the statistical model. Conclusions: Application of a statistical model including maternal symptoms, biochemical and haematological parameters has high diagnostic accuracy for earlier identification of AFLP. However, this finding needs to be tested in another cohort to determine whether this statistical model has the same performance.

Whole‐Genome Promoter Profiling of Plasma DNA Exhibits Diagnostic Value for Placenta‐Origin Pregnancy Complications

“…[ 7 ] Multivariate screening methods based on ultrasound examination and the quantification of diverse maternal urine and serum biomarkers have recently been proposed. [ 8–11 ] Some researchers have developed metabolomic biomarkers for the early pregnancy prediction of preeclampsia. [ 12,13 ] More reliable biomarkers for pregnancy complications are therefore needed to predict potential complications at early gestational age.…”

Acute fatty liver of pregnancy causes severe acute pancreatitis and stillborn fetus

“…Recently, Yan et al showed that the sensitivity and specificity of gastrointestinal symptoms +aminotransferase +bilirubin +bile acid +APTT/PT in the diagnosis of AFLP were 97.6% and 97.1% respectively, while more markers may be not conducive to the differential diagnosis. [ 15 ]…”

Second‐trimester acute fatty liver disease of pregnancy: A brief review of the literature and a case report

“…Liver biopsy is seldom performed and sonographic appearance of a shiny liver is seen only in 25% 3 . Moreover, many components are seen only late in the course of the disease, which renders this score inadequate for early identification 44 . Furthermore, it had poor prediction of the severity of the disease where some but not all parameters were found to predict selected outcome parameters 43 .…”

“…Different combinations of individual components of both scoring systems were used to predict the course and outcome of AFLP but failed to produce a clinically useful guide 43,45 . Nevertheless, recently Zhong et al were successful in reaching early diagnosis retrospectively in a statistical model, yet, this has to be confirmed by others in a prospective way 44 . In AFLP, the need for early diagnosis is of utmost importance for two reasons.…”