|
|
Hokkaido University Collection of Scholarly and Academic Papers >
Graduate School of Medicine / Faculty of Medicine >
Peer-reviewed Journal Articles, etc >
Association of antenatal antithrombin activity with perinatal liver dysfunction : A prospective multicenter study
| 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
|
