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Association of antenatal antithrombin activity with perinatal liver dysfunction : A prospective multicenter study

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Title: Association of antenatal antithrombin activity with perinatal liver dysfunction : A prospective multicenter study
Other Titles: Antithrombin deficiency in pregnancy
Authors: Morikawa, Mamoru Browse this author →KAKEN DB
Suzuki, Hirotada Browse this author
Obata-Yasuoka, Mana Browse this author →KAKEN DB
Kasai, Michi Browse this author
Itoh, Hiroaki Browse this author
Ohkuchi, Akihide Browse this author →KAKEN DB
Hamada, Hiromi Browse this author →KAKEN DB
Aoki, Shigeru Browse this author
Kanayama, Naohiro Browse this author
Minakami, Hisanori Browse this author →KAKEN DB
Keywords: acute fatty liver of pregnancy
antithrombin activity
disseminated intravascular coagulation
HELLP syndrome
maternal mortality
pregnancy complication
Issue Date: Jul-2017
Publisher: Wiley
Journal Title: Journal of gastroenterology and hepatology
Volume: 32
Issue: 7
Start Page: 1378
End Page: 1386
Publisher DOI: 10.1111/jgh.13714
PMID: 28012194
Abstract: Background and Aim: Liver dysfunction with decreased antithrombin activity (AT) 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 AST > 45 IU/L concomitant with lactate dehydrogenase (LDH) > 400 IU/L occurred in five women antenatally (≤ 2 weeks before delivery) and in 17 women postpartum (within 1 week postpartum). 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) vs. 86 (62 - 110)% and 179 (56 - 244) vs. 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 (PPV) of 8.6% and 14%, respectively, and combined use of AT and PLC improved sensitivity to 73% (16/22) with PPV 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 safety of pregnant women.
Rights: This is the peer reviewed version of the following article: Morikawa, M., Suzuki, H., Obata-Yasuoka, M., Kasai, M., Itoh, H., Ohkuchi, A., Hamada, H., Aoki, S., Kanayama, N., and Minakami, H. (2017) Association of antenatal antithrombin activity with perinatal liver dysfunction: A prospective multicenter study. Journal of Gastroenterology and Hepatology, 32: 1378–1386., which has been published in final form at http://dx.doi.org/10.1111/jgh.13714. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Type: article (author version)
URI: http://hdl.handle.net/2115/70899
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 水上 尚典

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