Clinical Characteristics And Early Warning Model Of Severe Liver Disease In Pregnancy

Objective :To explore the clinical characteristics of patients with severe liver disease during pregnancy,analyze the early progression of liver failure during pregnancy as the risk factors of liver failure during pregnancy,and establish an early warning model of liver failure.Methods:The clinical features,etiology,disease progression and prognosis of 81 patients with gestational liver disease were analyzed retrospectively.Univariate and multivariate logistic regression analysis was used to analyze the independent risk factors of liver failure and early warning models were established.The predictive value of the models were evaluated by receiver working characteristic curve(ROC curve).Results :All of the 81 patients,36(44.4%)developed liver failure,and most patients recovered after delivery and supportive treatment,but 6(7.4%)died.The causes were50 cases(61.7%)of viral hepatitis B(HBV)infection,27 cases(33.3%)of acute fatty liver of pregnancy(AFLP),3 cases(3.7%)of viral hepatitis B complicated with acute fatty liver of pregnancy(HBV+AFLP),and 1 case(1.2%)of viral hepatitis E(HEV).Overall,the short-term survival rate of patients who progressed to liver failure decreased significantly.Patients with acute fatty liver of pregnancy had a faster progression,a higher incidence of liver failure(P=0.004),and an increase in mortality but not statistically significant(P= 0.227).Multivariate logistic regression analysis showed that: 1.Abortion / stillbirth(OR=3008.93,P=0.006),elevated alanine aminotransferase(ALT)(OR=4.819,P=0.039)and decreased serum albumin(ALB)(OR=0.418,P=0.005)were independent risk factors for the progression of liver disease to liver failure in pregnant HBV patients.2.Increased prothrombin time(PT)level(OR=20.381,P=0.041)and decreased fasting blood glucose(FBG)level(OR=0.324,P=0.048)are independent risk factors for the progression of AFLP to liver failure.According to the above early warning indexes,the prediction models of liver failure of pregnancy were determined as follows:1.The early warning model of HBV liver failure during pregnancy,PAA model:Logit(P)=In[P/(1-P)]=1.573×[ln(ALT)(U/L)]-0.873×[ALB(g/L)]+10.312×[Miscarriage / stillbirth(yes = 1,no = 0)]+12.344。2.The early warning model of AFLP liver failure: PF model:Logit(P’)= in [P’/(1-p’)] = 3.015 × [PT(s)]-1.128 × [FBG(mmol/L)]-47.223.These models have high prediction efficiency by using the area under ROC curve(AUROC)analysis.the AUROC of PAA model is 0.943,(95%CI,0.864-1.00),the AUROC of PF model is 0.929,(95%CI,0.837-1.00),(all AUROCs are over 0.8).Conclusions :The progression of severe liver disease during pregnancy is closely related to the etiology.Abortion or stillbirth,increased ALT level and decreased serum albumin(ALB)level were independent risk factors for hepatitis B related liver failure during pregnancy,while increased prothrombin time(PT)level and decreased fasting blood glucose(FBG)were independent risk factors for acute fatty liver failure in pregnancy.The early warning model of HBV liver failure in pregnancy and the early warning model of AFLP liver failure have high predictive efficiency.