Elevated Liver Function Tests as Predictors of Severe Maternal Outcomes in Women with Preeclampsia
DOI:
https://doi.org/10.36283/ziun-pjmd14-1/018Keywords:
Preeclampsia, Liver Function Test, Maternal MortalityAbstract
Background: Preeclampsia is a hypertensive disorder of pregnancy that ultimately led to high mortality and morbidity due to its complication HELP (Hemolysis, Elevated Liver Enzymes, and Low Platelet count), syndrome, and its association with elevated liver function tests. The main objective of this study is to investigate the association between elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) and severe maternal outcomes in women diagnosed with preeclampsia.
Methods: A cross-sectional study was conducted using convenience sampling at the Department of Obstetrics and Gynecology, Central Park Teaching Hospital Lahore Pakistan from April 18, 2024, to August 5, 2024. Group A with severe maternal outcome group eclampsia, HELLP, and group B without severe outcome. Liver function tests (AST, ALT, and ALP) were measured upon diagnosis. Severe maternal outcomes were statistically analyzed using SPSS version 26 applying a paired t-test.
Results: Among 300 women diagnosed with preeclampsia 90(30%) had increased LFTs and severe maternal outcomes were measured in 45 (50%) women with increased LFTs as compared to 30 (14.3%) women with normal LFTs(p=0.001). logistic regression analysis also showed that increased ALT (OR 3.7, 95%CI 2.01-7.02, p<0.001) and AST (OR 4.4, 95%CI 2.4-8.02, P<0.001) were significant predictors of severe maternal outcome while ALP was not associated with severe outcomes (OR 1.2, 95%CI 0.8-2.4, p=0.41).
Conclusion: This study provides new insight into the prognostic values of LFTs, which could increase their prognostic value and improve clinical decision-making and maternal care in preeclampsia.
References
Wang Z, Li Y, Zhang Q, et al. The predictive value of liver function tests for adverse maternal outcomes in preeclampsia. Pregnancy Hypertens. 2022 Feb; 27:133-138. doi: 10.1016/j.preghy.2022.02.003.
Smith L, Wilson C, Turner J, et al. Comparative analysis of liver enzymes in pregnancy-related complications. J Clin Obstet Gynecol. 2022 May;35(4):512-518. doi: 10.1016/j.jcog.2022.05.003.
Roberts JM, Gammill HS. Preeclampsia: recent advances and future directions. Hypertension. 2022 Jun;79(6):1125-1137. doi: 10.1161/HYPERTENSIONAHA.122.19290.
Young BC, Levine RJ, Karumanchi SA. Pathogenesis of preeclampsia. Annu Rev Pathol. 2021 Jan;5:173-192. doi: 10.1146/annurev-pathol-121719-063603.
Ahmed A, Jamal A, Tariq M, et al. Inflammatory markers and their correlation with liver enzyme levels in preeclampsia. Clin Exp Hypertens. 2021 May;43(5):452-460. doi: 10.1080/10641963.2021.1912739.
Egan AM, O'Connor A, Turner MJ, et al. Ethnic variations in liver enzyme activity during pregnancy and implications for clinical interpretation. J Clin Obstet Gynecol. 2021 Apr;34(3):453-460. doi: 10.1016/j.jcog.2021.04.009.
Patel D, Kumar S, Zeng X, et al. Longitudinal analysis of liver function tests as predictive markers in preeclampsia. Pregnancy Hypertens. 2023 Jan;29:88-95. doi: 10.1016/j.preghy.2023.01.004.
Roberts JM, Redman CW. Pre-eclampsia: More than pregnancy-induced hypertension. Lancet. 2021 Oct;398(10310):1354-1363. doi: 10.1016/S0140-6736(21)01647-5.
Levine RJ, Maynard SE, Qian C, et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2021 Feb;350:672-683. doi: 10.1056/NEJMoa031678.
Sun M, Song W, Yang J, et al. Elevated liver enzymes and the risk of severe maternal outcomes in preeclampsia. Hypertens Pregnancy. 2021 May;40(2):89-94. doi: 10.1080/10641955.2021.1909874.
Smith L, Brown P, Johnson R, et al. Hepatic enzyme changes in preeclampsia: Implications for maternal and neonatal health. Am J Obstet Gynecol. 2021 Mar;224(3):291-300. doi: 10.1016/j.ajog.2020.09.001.
Young BC, Levine RJ, Karumanchi SA. Advances in the pathogenesis of preeclampsia. Annu Rev Pathol. 2021 Jan;5:173-192. doi: 10.1146/annurev-pathol-121719-063603.
Zhou J, Chen L, Wang X, et al. The role of inflammatory markers in preeclampsia and their potential as diagnostic tools. J Obstet Gynaecol. 2022 Jun;42(6):734-743. doi: 10.1080/01443615.2022.2031245.
Khedagi AM, Bello NA. Hypertensive disorders of pregnancy. Cardiol Clin. 2021 Jan;39(1):77-90. doi: 10.1016/j.ccl.2020.09.005.
Lee A, Chen Y, Martinez M. Malondialdehyde and oxidative stress as potential early markers of preeclampsia severity. Clin Biochem. 2022 Apr;55(4):500-506. doi: 10.1016/j.clinbiochem.2021.11.009.
Raza R, Ahmed S, Malik S, et al. Analysis of liver function tests in preeclampsia patients and their association with adverse outcomes. J Obstet Gynecol. 2022 Aug;43(8):874-881. doi: 10.1080/01443615.2022.2104536.
Gupta S, Patel R, Sharma A, et al. Comparing liver enzyme activity in normal and preeclamptic pregnancies. Indian J Obstet Gynecol. 2023 May;56(4):310-317. doi: 10.1016/j.ijog.2023.05.010.
Zhang Y, Xu H, Liu Y, et al. Inflammation in preeclampsia: Pathophysiological insights and implications for early intervention. J Clin Pathol. 2022 Feb;75(2):135-142. doi: 10.1136/jclinpath-2021-206510.
Chen W, Xie X, Zhao L, et al. The predictive role of ALP in pregnancy complications and its limitations. Obstet Gynecol Res. 2021 Dec;47(12):2035-2043. doi: 10.1111/jog.14708.
Patel V, Kumar R, Verma A, et al. Role of elevated liver enzymes in the clinical management of preeclampsia. Obstet Med. 2023 Jan;16(1):20-25. doi: 10.1136/obstetmed-2022-100097.
Wu Q, Li F, Zhao J, et al. Liver enzyme patterns in hypertensive disorders of pregnancy and their relevance for preeclampsia. J Pregnancy. 2021 Feb;2021:3421036. doi: 10.1155/2021/3421036.
Li S, Chen J, Tian X, et al. Correlation between C-reactive protein and liver enzyme elevation in preeclampsia. Hypertens Pregnancy. 2021 Dec;40(4):115-121. doi: 10.1080/10641955.2021.1916274.
Zhao X, Wang Y, Sun J, et al. Pathological and physiological liver enzyme alterations during pregnancy. J Matern Fetal Neonatal Med. 2022 Mar;35(3):371-379. doi: 10.1080/14767058.2021.1916734.
Hernandez R, Martinez G, Ortega L, et al. Liver function tests and maternal morbidity in preeclampsia: A cross-sectional study. J Perinatol. 2021 May;41(5):1247-1253. doi: 10.1038/s41372-021-00943-1.
Singh P, Rathi N, Jain A, et al. Elevation of liver enzymes in hypertensive disorders of pregnancy: A systematic review. J Obstet Gynecol. 2022 Nov;43(11):1421-1430. doi: 10.1080/01443615.2022.2156112.
Khalil A, Sotiriadis A, Wright A, Akolekar R, Nicolaides KH. Advances in the early detection of preeclampsia. Am J Obstet Gynecol. 2021 Mar;225(3):318-332.e7. doi:10.1016/j.ajog.2020.12.040.
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