Pregnancy-associated acute liver disease and acute viral hepatitis

Differentiation, course and outcome

Harshad Devarbhavi, Walter K Kremers, Ross Dierkhising, Lakshmi Padmanabhan

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background/Aims: Pregnant women with acute viral hepatitis (VH) and those with pregnancy associated acute liver disease (PAALD) including acute fatty liver disease of pregnancy, hemolysis elevated liver enzyme and low platelet syndrome present with similar clinical features and liver tests abnormalities. Accurate differentiation between the two groups is critical to expedite early delivery in the latter and prevent progressive liver damage. There is scant data in the literature to differentiate between PAALD and VH. Methods: We studied the clinical variables, hematological, biochemical and viral serological tests of 87 consecutive pregnant patients with jaundice from 2000 to 2003. Results: There were 46 and 41 patients in PAALD and VH group, respectively. Two-thirds in VH group were due to hepatitis E. Univariate analysis identified hypertension, encephalopathy, oliguria, ascites, serum creatinine, and low platelets as significantly more common in the PAALD group. Multivariate analysis and recursive partitioning identified hypertension and ascites as predictors of PAALD with excellent predictive ability and c value of 0.92. Mortality was 41% in PAALD and 7.5% in VH. Increased bilirubin and oliguria were predictors of mortality in PAALD. Conclusions: Presence of ascites and hypertension differentiates PAALD from VH and should prompt early delivery. Mortality due to hepatitis E is low.

Original languageEnglish (US)
Pages (from-to)930-935
Number of pages6
JournalJournal of Hepatology
Volume49
Issue number6
DOIs
StatePublished - Dec 2008

Fingerprint

Acute Disease
Hepatitis
Liver Diseases
Pregnancy
Ascites
Hepatitis E
Oliguria
Hypertension
Mortality
Liver
Blood Platelets
Brain Diseases
Serologic Tests
Hemolysis
Jaundice
Bilirubin
Pregnant Women
Creatinine
Multivariate Analysis
Enzymes

Keywords

  • Ascites
  • HELLP
  • Hepatitis E
  • Hypertension
  • Liver failure
  • Preeclampsia

ASJC Scopus subject areas

  • Hepatology

Cite this

Pregnancy-associated acute liver disease and acute viral hepatitis : Differentiation, course and outcome. / Devarbhavi, Harshad; Kremers, Walter K; Dierkhising, Ross; Padmanabhan, Lakshmi.

In: Journal of Hepatology, Vol. 49, No. 6, 12.2008, p. 930-935.

Research output: Contribution to journalArticle

Devarbhavi, Harshad ; Kremers, Walter K ; Dierkhising, Ross ; Padmanabhan, Lakshmi. / Pregnancy-associated acute liver disease and acute viral hepatitis : Differentiation, course and outcome. In: Journal of Hepatology. 2008 ; Vol. 49, No. 6. pp. 930-935.
@article{85e014a0340d49748a8b0be76e1b39bf,
title = "Pregnancy-associated acute liver disease and acute viral hepatitis: Differentiation, course and outcome",
abstract = "Background/Aims: Pregnant women with acute viral hepatitis (VH) and those with pregnancy associated acute liver disease (PAALD) including acute fatty liver disease of pregnancy, hemolysis elevated liver enzyme and low platelet syndrome present with similar clinical features and liver tests abnormalities. Accurate differentiation between the two groups is critical to expedite early delivery in the latter and prevent progressive liver damage. There is scant data in the literature to differentiate between PAALD and VH. Methods: We studied the clinical variables, hematological, biochemical and viral serological tests of 87 consecutive pregnant patients with jaundice from 2000 to 2003. Results: There were 46 and 41 patients in PAALD and VH group, respectively. Two-thirds in VH group were due to hepatitis E. Univariate analysis identified hypertension, encephalopathy, oliguria, ascites, serum creatinine, and low platelets as significantly more common in the PAALD group. Multivariate analysis and recursive partitioning identified hypertension and ascites as predictors of PAALD with excellent predictive ability and c value of 0.92. Mortality was 41{\%} in PAALD and 7.5{\%} in VH. Increased bilirubin and oliguria were predictors of mortality in PAALD. Conclusions: Presence of ascites and hypertension differentiates PAALD from VH and should prompt early delivery. Mortality due to hepatitis E is low.",
keywords = "Ascites, HELLP, Hepatitis E, Hypertension, Liver failure, Preeclampsia",
author = "Harshad Devarbhavi and Kremers, {Walter K} and Ross Dierkhising and Lakshmi Padmanabhan",
year = "2008",
month = "12",
doi = "10.1016/j.jhep.2008.07.030",
language = "English (US)",
volume = "49",
pages = "930--935",
journal = "Journal of Hepatology",
issn = "0168-8278",
publisher = "Elsevier",
number = "6",

}

TY - JOUR

T1 - Pregnancy-associated acute liver disease and acute viral hepatitis

T2 - Differentiation, course and outcome

AU - Devarbhavi, Harshad

AU - Kremers, Walter K

AU - Dierkhising, Ross

AU - Padmanabhan, Lakshmi

PY - 2008/12

Y1 - 2008/12

N2 - Background/Aims: Pregnant women with acute viral hepatitis (VH) and those with pregnancy associated acute liver disease (PAALD) including acute fatty liver disease of pregnancy, hemolysis elevated liver enzyme and low platelet syndrome present with similar clinical features and liver tests abnormalities. Accurate differentiation between the two groups is critical to expedite early delivery in the latter and prevent progressive liver damage. There is scant data in the literature to differentiate between PAALD and VH. Methods: We studied the clinical variables, hematological, biochemical and viral serological tests of 87 consecutive pregnant patients with jaundice from 2000 to 2003. Results: There were 46 and 41 patients in PAALD and VH group, respectively. Two-thirds in VH group were due to hepatitis E. Univariate analysis identified hypertension, encephalopathy, oliguria, ascites, serum creatinine, and low platelets as significantly more common in the PAALD group. Multivariate analysis and recursive partitioning identified hypertension and ascites as predictors of PAALD with excellent predictive ability and c value of 0.92. Mortality was 41% in PAALD and 7.5% in VH. Increased bilirubin and oliguria were predictors of mortality in PAALD. Conclusions: Presence of ascites and hypertension differentiates PAALD from VH and should prompt early delivery. Mortality due to hepatitis E is low.

AB - Background/Aims: Pregnant women with acute viral hepatitis (VH) and those with pregnancy associated acute liver disease (PAALD) including acute fatty liver disease of pregnancy, hemolysis elevated liver enzyme and low platelet syndrome present with similar clinical features and liver tests abnormalities. Accurate differentiation between the two groups is critical to expedite early delivery in the latter and prevent progressive liver damage. There is scant data in the literature to differentiate between PAALD and VH. Methods: We studied the clinical variables, hematological, biochemical and viral serological tests of 87 consecutive pregnant patients with jaundice from 2000 to 2003. Results: There were 46 and 41 patients in PAALD and VH group, respectively. Two-thirds in VH group were due to hepatitis E. Univariate analysis identified hypertension, encephalopathy, oliguria, ascites, serum creatinine, and low platelets as significantly more common in the PAALD group. Multivariate analysis and recursive partitioning identified hypertension and ascites as predictors of PAALD with excellent predictive ability and c value of 0.92. Mortality was 41% in PAALD and 7.5% in VH. Increased bilirubin and oliguria were predictors of mortality in PAALD. Conclusions: Presence of ascites and hypertension differentiates PAALD from VH and should prompt early delivery. Mortality due to hepatitis E is low.

KW - Ascites

KW - HELLP

KW - Hepatitis E

KW - Hypertension

KW - Liver failure

KW - Preeclampsia

UR - http://www.scopus.com/inward/record.url?scp=55749096745&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=55749096745&partnerID=8YFLogxK

U2 - 10.1016/j.jhep.2008.07.030

DO - 10.1016/j.jhep.2008.07.030

M3 - Article

VL - 49

SP - 930

EP - 935

JO - Journal of Hepatology

JF - Journal of Hepatology

SN - 0168-8278

IS - 6

ER -