Association of antenatal antithrombin activity with perinatal liver dysfunction: A prospective multicenter study. Issue 7 (22nd June 2017)

• Record Type: Journal Article
• Authors: Morikawa, Mamoru; Suzuki, Hirotada; Obata‐Yasuoka, Mana; Kasai, Michi; Itoh, Hiroaki; Ohkuchi, Akihide; Hamada, Hiromi; Aoki, Shigeru; Kanayama, Naohiro; Minakami, Hisanori
• Is Part Of: Journal of gastroenterology and hepatology. Volume 32:Issue 7(2017)
• Page Start: 1378
• Page End: 1386
• Publication Date: 2017-06-22
• Subjects: acute fatty liver of pregnancy -- antithrombin activity -- disseminated intravascular coagulation -- HELLP syndrome -- maternal mortality -- pregnancy complication; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Liver Diseases -- Periodicals; 616.33
• DOI: 10.1111/jgh.13714
• Languages: English
• ISSNs: 0815-9319

Abstract

Abstract: Background and Aim: Liver dysfunction with decreased antithrombin (AT) activity and/or thrombocytopenia is life threatening in pregnant women. Whether AT is clinically useful for prediction of liver dysfunction remains unclear. Methods: A total of 541 women were registered prospectively at gestational week 34.7 (20.0–41.4) with available data on antenatal AT and platelet count (PLC). Results: Liver dysfunction defined as serum aspartate aminotransferase > 45 IU/L concomitant with lactate dehydrogenase > 400 IU/L occurred in five women antenatally (≤ 2 weeks before delivery) and in 17 women post‐partum (within 1 week post‐partum). Median (5th–95th) antenatal value was 85 (62–110)% for AT and 202 (118–315) × 10 9 /L for PLC in the 541 women and was significantly lower in women with than without perinatal liver dysfunction; 75 (51–108) versus 86 (62–110)% and 179 (56–244) versus 203 (121–316) × 10 9 /L, respectively. Nineteen (86%) women with liver dysfunction showed AT ≤ 62% or thrombocytopenia (PLC ≤ 118 × 10 9 /L) perinatally, but five lacked thrombocytopenia throughout the perinatal period. The best cut‐off (AT, 77%; PLC, 139 × 10 9 /L) suggested by receiver operating characteristic curve gave antenatal AT and PLC sensitivity of 59% and 41% with positive predictive value of 8.6% and 14%, respectively, and combined use of AT and PLC improved sensitivity to 73% (16/22) with positive predictive value of 9.2% for prediction of perinatal liver dysfunction. Conclusions: Reduced AT not accompanied by thrombocytopenia can precede liver dysfunction. Clinical introduction of AT may enhance the safety of pregnant women.