Non-Invasive Markers (ALBI and APRI) Predict Pregnancy Outcomes in Women With Chronic Liver Disease

Gonsalkorala, E.; Cannon, Mary; Lim, Tiong Yeng; Penna, Leonie; Willliamson, Catherine; Heneghan, Michael A.

doi:10.1038/s41395-018-0181-x

Cited by 34 publications

(38 citation statements)

References 19 publications

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“…In recent years, the combined analysis of liver enzymes and platelet counts has provided important information regarding the role of new biomarkers in predicting neoplastic and infectious disease severity [47, 48]. One of these biomarkers, the APRI, has been widely studied as a minimally invasive marker of fibrosis and inflammation in hepatic disease [49, 50]. The APRI has also proven useful in predicting the severity of acute and systemic diseases such as dengue [19] and HELLP syndrome [51].…”

Section: Discussionmentioning

confidence: 99%

Aspartate aminotransferase-to-platelet ratio index (APRI): A potential marker for diagnosis in patients at risk of severe malaria caused by Plasmodium vivax

et al. 2019

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Acute infection with Plasmodium vivax, classically associated with benign disease, has been presenting as serious and even fatal disease in recent years. Severe disease is mainly due to biochemical and hematological alterations during the acute phase of infection. In the present cross-sectional study, the aspartate aminotransferase-to-platelet ratio index (APRI) was evaluated as a method for identifying patients at risk of severe vivax malaria. This retrospective study included 130 patients with confirmed P. vivax infection between June 2006 and January 2018. Clinical-epidemiological data were obtained from medical records. Hematological and biochemical parameters were determined using automated equipment. The criteria of severity for infection by Plasmodium falciparum, established by the World Health Organization (WHO), were adapted to classify patients with danger signs of severe vivax malaria. Of the 130 patient’s records evaluated, 19 (14.6%) had one or more signs and symptoms of severe malaria. The mean APRI values among patients with and without severe malaria were 2.11 and 1.09, respectively (p = 0.044). Among those with severe disease, the proportion with an APRI value above 1.50 was 30% compared to the 10% among those without severe disease (p = 0.007). The area under the receiver operating characteristic curve (95% CI), calculated to assess the accuracy of the APRI in discriminating between patients with and without severe disease, was 0.645 (0.494; 0.795). An APRI cutoff of 0.74 resulted in sensitivity of 74.0%, specificity of 56.0%, and accuracy of 65.0%. This study shows that the APRI is elevated in patients with evidence of infection by P. vivax. Based on the good sensitivity found in this study, we conclude that this simple index can serve as a diagnostic biomarker to identify patients at risk of severe disease during the acute phase of P. vivax infection.

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Section: Discussionmentioning

confidence: 99%

Aspartate aminotransferase-to-platelet ratio index (APRI): A potential marker for diagnosis in patients at risk of severe malaria caused by Plasmodium vivax

et al. 2019

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“…For active variceal hemorrhage, immediate resuscitation and stabilization of the mother and emergent endoscopic therapy are required. (113,200,(326)(327)(328) Octreotide or somatostatin should also be initiated, but terlipressin should be avoided because it can cause uterine contractions and reduce uterine blood flow (Table 4). Although splanchnic vasoconstriction could reduce placental perfusion and increase risk of placental abruption, (329) comprehensive management of life-threatening variceal bleeding outweighs this theoretical risk.…”

Section: Management Of Gastroesophageal Variceal Bleedingmentioning

confidence: 99%

Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases

et al. 2021

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“…In this cohort, it was also observed that a platelet count before conception of 110 × 10 9 cells/L or less had 78% sensitivity and 89% specificity in predicting the presence of varices on screening endoscopy performed during the second trimester of pregnancy. A more recent investigation of the albumin–bilirubin score and the AST to platelet ratio index determined that these measures in preconception were predictive of live birth and of the ability of pregnancies in women with chronic liver disease and cirrhosis to progress beyond 37 weeks of gestation . Investigators in Germany performed transient elastography on healthy women who were pregnant and on women with pregnancy‐related liver disease (preeclampsia and ICP) .…”

Section: Future Directions: Noninvasive Testing and Prognostic Modelsmentioning

confidence: 99%

Liver Disease in Pregnancy: What's New

Brady

2020

Hepatol Commun

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Liver disease in pregnancy may present as a disorder that is unique to pregnancy or as an acute or chronic liver disease occurring coincidentally in pregnancy. Hepatic diseases that are unique to pregnancy include hyperemesis gravidarum; preeclampsia/eclampsia; the syndrome of hemolysis, elevated liver enzymes, and low platelets; intrahepatic cholestasis of pregnancy; and acute fatty liver of pregnancy. Acute and chronic forms of primary hepatic disorders that are seen in pregnancy include viral hepatitis, autoimmune hepatitis, nonalcoholic fatty liver disease, and cirrhosis. Because of the need to consider both maternal and fetal health, there are special considerations for the implementation of diagnostic strategies and pharmacologic therapies for liver disease that occurs in pregnancy. An understanding of the pathogenesis and expression of liver diseases in pregnancy has been evolving, and various diagnostic and prognostic tools have been studied in order to determine noninvasive approaches to identifying and staging of such diseases. Investigations have also been underway to evaluate the safety and utility of existing and new therapeutic agents that previously were thought to not be compatible with pregnancy. This review will explore updates in the epidemiology, diagnosis, and management of various liver diseases seen in pregnancy. (Hepatology Communications 2020;4:145-156).

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Non-Invasive Markers (ALBI and APRI) Predict Pregnancy Outcomes in Women With Chronic Liver Disease

Abstract: Most women with cirrhosis who conceived achieved a successful pregnancy outcome. ALBI and APRI scores can prognosticate pregnancy outcomes in women with CLD. Preconception counseling by a hepatologist or specialist obstetrician improved patient care in this group.

Cited by 34 publications

References 19 publications

Aspartate aminotransferase-to-platelet ratio index (APRI): A potential marker for diagnosis in patients at risk of severe malaria caused by Plasmodium vivax

Aspartate aminotransferase-to-platelet ratio index (APRI): A potential marker for diagnosis in patients at risk of severe malaria caused by Plasmodium vivax

Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases

Liver Disease in Pregnancy: What's New

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