Outcome And Risk Factors Of Patients With Acute Fatty Liver Of Pregnancy:A Multicentre Retrospective Study

ObjectiveAcute fatty liver of pregnancy(AFLP)is exceptional in obstetrics and is also a critical illness that needs to be admitted to the critical care unit.It frequently causes multiple organ failure such as liver and kidney in pregnant women.At present,the etiology and pathogenesis of acute fatty liver of pregnancy is not very clear.It may be related to the disturbance of fatty acid metabolism caused by the change of hormone level during pregnancy.The rapid development and relatively high mortality of AFLP behoves a better understanding of its clinical characteristics,management,outcomes and risk factors.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,so as to provide certain evidence for clinical diagnosis and decision-making.MethodsThis was a retrospective cohort study of 133 patients with AFLP hospitalised at four tertiary hospitals in China between January 2009 and April 2014.The clinical features and laboratory findings were summarized.Univariate analysis and multivariate logistic regression were used to analyze risk factors.ResultsAmong 133 patients with AFLP,for 13(9.8%)patients,AFLP was diagnosed in the postpartum period.111(83.5%)mothers were recovered and 125(77.6%)fetuses survived.The main manifestations were anorexia(50.4%),jaundice(47.4%),ascites(45.1%),nausea(42.9%),vomiting(36.1%)and abdominal pain(30.8%).Moreover,the complications included coagulopathy(85.7%),hypoproteinemia(82.0%),hypoglycemia(57.1%),acute kidney injury(55.6%),acute liver failure(33.1%),hepatic encephalopathy(28.6%),disseminated intravascular coagulation(20.3%),postpartum hemorrhage(12.8%),acute renal failure(9.8%),Hyperglycaemia(9.8%),gastrointestinal bleeding(7.5%),multiple organ system failure(6.8%)and pancreatitis(6.8%).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)were potential factors influencing adverse maternal outcome.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 legalised 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).ConclusionAcute fatty liver of pregnancy occurring in the late stage of pregnancy or in the early puerperium is rare but very dangerous.The main prodromic symptoms may be anorexia,nausea,vomiting and abdominal pain.Moreover,the common signs may be progressive jaundice and ascites.The male fetus,postpartum diagnosis of AFLP,intrauterine fetal death,disseminated intravascular coagulation,prolonged prothrombin time and prolonged activated partial thromboplastin time are the potential risk factors of maternal outcome.The fetal distress and prolonged activated partial thromboplastin time are the risk factor of fetal mortality.Compared with total bilirubin and serum creatinine,history of legalised termination,of pregnancy appeared to be a greater risk factor for maternal mortality among patients with AFLP.More studies on acute fatty liver of pregnancy are needed in order to better guide the clinical work.