Outcomes and risk factors of patients with acute fatty liver of pregnancy: a multicentre retrospective study.

Qiang Gao; Xin QU; Xiukai Chen; Jicheng Zhang; Fen Liu; Suochen Tian; Chunting Wang

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Outcomes and risk factors of patients with acute fatty liver of pregnancy: a multicentre retrospective study.

Author: Qiang GAO ¹ ; Xin QU ² ; Xiukai CHEN ³ ; Jicheng ZHANG ¹ ; Fen LIU ⁴ ; Suochen TIAN ⁵ ; Chunting WANG ¹
Author Information

1. Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
2. Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China.
3. Center for Critical Care Nephrology, University of Pittsburgh, School of Medicine, Pittsburgh, USA.
4. Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.
5. Department of Critical Care Medicine, Liaocheng People's Hospital, Liaocheng, China.
Publication Type:Journal Article
Keywords: fatty liver; liver failure; patient outcome assessment; pregnancy complications; risk factors
From:Singapore medical journal 2018;59(8):425-430
CountrySingapore
Language:English
Abstract:
INTRODUCTIONAcute fatty liver of pregnancy (AFLP) frequently causes liver failure in pregnant women. A better understanding of the clinical characteristics, management, outcomes and risk factors of AFLP is required, given its relatively high mortality rate. We aimed to describe the characteristics of AFLP, and further assess its outcomes and potential risk factors from the perspectives of the mother and fetus.
METHODSThis was a retrospective cohort study of 133 patients with AFLP hospitalised at four tertiary hospitals in China between January 2009 and April 2014.
RESULTSAmong 133 patients, AFLP was diagnosed in the postpartum period for 13 (9.8%) patients. Potential factors influencing adverse maternal outcome were male fetus (p = 0.04), postpartum diagnosis of AFLP (p < 0.01), intrauterine fetal death (p = 0.04), disseminated intravascular coagulation (p < 0.01), prothrombin time (p < 0.01) and activated partial thromboplastin time (p = 0.04). The frequency of fetal distress (p = 0.03) and activated partial thromboplastin time (p < 0.05) were significantly higher in pregnancies with dead fetuses than in those where the fetuses survived. Independent risk factors for perinatal maternal mortality were history of legal termination of pregnancy (odds ratio [OR] 1.958, 95% confidence interval [CI] 1.133-3.385), total bilirubin (OR 1.009, 95% CI 1.003-1.014) and serum creatinine (OR 1.010, 95% CI 1.003-1.017).
CONCLUSIONCompared with total bilirubin and serum creatinine, history of legal termination of pregnancy appeared to be a greater risk factor for maternal mortality among patients with AFLP.