Acute Fatty Liver Of Pregnancy Research Articles

#1799 Liver affliction among women with pregnancy-related acute kidney injury and its impact on fetal and maternal outcome

Abstract Background and Aims Pregnancy-related acute kidney injury (PR-AKI) is a worldwide health challenge that is accompanied by an increased risk of morbidity and mortality in both the mother and the fetus. PR-AKI occurs due to several causes including prerenal (hemorrhage, sepsis, hypovolemia, etc), postrenal and intrinsic renal causes (renal cortical necrosis, acute tubular necrosis, thrombotic microangiopathy [TMA], hemolysis elevated liver enzymes, low platelet count (HELLP) syndrome, preeclampsia/eclampsia, acute fatty liver of pregnancy (AFLP), glomerulonephritis [GN], etc). Hepatic affection in the context of PR-AKI may further compromise the detrimental maternal and fetal outcomes, however this seldom has been studied. Thus, this study aimed to explore the incidence of liver affliction in women with PR-AKI and to investigate its effect on the maternal and fetal outcome. Method This three-year retrospective study included women who presented to Mansoura Nephrology and Dialysis Unit with severe PR-AKI. Patients with stage I, II AKI admitted to obstetric departments were not included in the study. Patients with incomplete data were excluded from the study. The routine laboratory data and fetal and maternal outcomes were obtained from the medical records. Results The study included 77 women with PR-AKI, the mean maternal age was 28 with a minimum of 19 and maximum of 43 years. Twelve patients had hypertension while none of them had diabetes. The causes of PR-AKI are displayed in Fig. 1. Thirty-one patients (40.3%) had liver affliction. Six of them were due to HELLP, three due to underlying liver cirrhosis, one due to AFLP, the remaining cases showed abnormally elevated liver enzymes. White blood cells and INR were significantly higher among women with liver affliction than those without (P = 0.023, 0.003, respectively), while platelets were significantly lower in women with liver affliction (P = 0.002). Patients with liver affliction showed significantly higher median alanine transaminase (99 vs 27) and aspartate transaminase (103 vs 23) than those without (P < 0.001 for both). On the other hand, there were no statistically significant differences between patients with and without liver affliction as regard blood hemoglobin, serum creatinine, quantitative proteinuria, bicarbonate, and gestational age at termination of pregnancy. The studied women with liver affliction experienced lower percentage of renal recovery compared to those without but with no statistical significance (54.8%vs72.5%, P = 0.122). Maternal mortality was significantly more among patients with liver affliction compared to those without (32.3% vs 9.8%, P = 0.017). On the other hand, there was no significant difference between patients with and without liver affection regarding fetal outcome (live birth 55.2% vs 55.6%, P = 0.975) (Table 1). Conclusion Liver affliction is not uncommon problem among women with PR-AKI and it is associated with higher maternal mortality and lower rates of renal recovery.

Acute liver failure in pregnancy.

Liver function abnormalities are noted in a minority of pregnancies with multiple causes for the same. A small proportion of these develop severe liver injury and progress to acute liver failure (ALF). There is a discrete set of etiology for ALF in pregnancy and comprehensive understanding will help in urgent evaluation. Certain diseasessuch as acute fatty liver of pregnancy, hemolysis, elevated liver enzyme, low platelet (HELLP) syndrome and pre-eclampsia are secondary to pregnant state and can present as ALF. Quick and targeted evaluation with urgent institution of etiology-specific management, especially urgent delivery in patients with pregnancy-associated liver diseases, is the key to avoiding maternal deaths. Pregnancy, as also the fetal life, imparts a further layer of complication in assessment, prognosis and management of these sick patients with ALF. Optimal management often requires a multidisciplinary approach in a well-equipped centre. In this review, we discuss evaluation, assessment and management of pregnant patients with ALF, focussing on approach to pregnancy-associated liver diseases.

Enfermedades hepáticas relacionadas con el embarazo

Pregnancy-related liver diseases are an important cause of maternal and infant morbidity and mortality. The diagnosis should always be a diagnosis of exclusion (viral, autoimmune, or drug-related liver diseases or biliopancreatic diseases). Pregnancy-related liver diseases include hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, preeclampsia, eclampsia, HELLP syndrome, and acute fatty liver of pregnancy.

6299488 Navigating Diagnostic Dilemmas: Distinguishing Acute Fatty Liver of Pregnancy from HELLP syndrome – A Case Report

6299488 Navigating Diagnostic Dilemmas: Distinguishing Acute Fatty Liver of Pregnancy from HELLP syndrome – A Case Report

Plasma exchange improves survival in acute liver failure- An updated systematic review and meta-analysis focussed on comparing within single etiology.

Therapeutic plasma exchange (PLEX) is increasingly used in patients with acute liver failure (ALF) as either stand-alone therapy or bridge to liver transplantation. Etiology plays a major role in prognosis of these patients and benefit of PLEX may consequently differ across etiologies. This systematic review and meta-analysis aims to evaluate the efficacy of PLEX in treating ALF, focussing on studies with single etiology. We conducted a systematic literature search and identified studies comparing PLEX vs. standard medical therapy (SMT) for patients with ALF across all age groups. The protocol was registered in theInternational Prospective Register of Systematic Reviews (PROSPERO) (CRD42023442383). Pooled risk-ratios were determined by Mantel-Haenszel method within a random effect model. Primary outcome was mortality at ≤ 60-days and 90days. Secondary outcome was adverse events attributable to PLEX. Eight studies (pooled sample size in PLEX arm:284; randomized trials:2; Comparative cohorts:6) with retrievable data on ALF were included in this systematic review. Analysis showed that PLEX was associated with significant reduction in mortality at ≤ 60-days (RR 0.64; CI, 0.51-0.80; P < 0.001) and at 90-days (RR 0.67; CI, 0.50-0.90; P = 0.008) as compared to SMT. On sub-group analysis, the survival benefit was noted irrespective of the volume of plasma exchanged during PLEX. Three studies (pooled sample size in PLEX arm: 110; all comparative cohorts) were identified, which included patients with a single etiology for ALF. These studies included patients with Wilson's disease, rodenticidal hepatotoxicity and acute fatty liver of pregnancy. Pooled analysis of studies with single etiology ALF showed better reduction in ≤ 90-day mortality with PLEX (RR 0.53; CI, 0.37-0.74; P < 0.001). Studies reported no major side-effects attributable to PLEX. PLEX is safe and improves survival, independent of the volumes utilized, in patients with ALF as compared to standard medical treatment. The survival benefit is especially pronounced in studies restricted to single etiology.

Unique presentation of previable HELLP syndrome

Introduction: Hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome is a serious complication of pregnancy characterized by hemolysis, elevated liver enzymes, and low platelets. This condition typically affects pregnant women in the third trimester or postpartum states, with only a handful of reported cases in previable pregnancies. The symptoms of HELLP syndrome can mimic those of other critical conditions during pregnancy, such as acute fatty liver of pregnancy (AFLP), thrombotic thrombocytopenic purpura (TTP), hemolytic-uremic syndrome (HUS), systemic lupus erythematosus (SLE), and antiphospholipid syndrome (APS), making early diagnosis crucial to prevent maternal and fetal harm. Case Report: We report the case of a 23-year-old nulliparous woman who developed HELLP syndrome at 21 weeks gestation. We highlight the importance of recognizing early onset HELLP syndrome and differentiating it from other potential diagnoses to ensure prompt and appropriate treatment. Conclusion: This case of previable HELLP syndrome in a nulliparous patient without other risk factors highlights the importance of early detection and intervention as life saving measures. By understanding the clinical and laboratory findings specific to HELLP syndrome, healthcare providers can improve maternal and fetal outcomes in cases of this rare and serious complication of pregnancy.

Acute Kidney Injury in Pregnancy: A Prospective Study.

When acute kidney damage occurs during pregnancy, it poses a difficult clinical problem. One of the main causes of maternal and fetal morbidity and death is pregnancy-related acute kidney injury (AKI), a significant obstetric complication characterized by a fast deterioration in renal function and several subsequent clinical problems. The objective of the study is to analyze the etiological factors, clinical manifestations, and maternal and fetal outcomes of AKI during pregnancy. This prospective observational research involved patients hospitalized in the General Medicine and Obstetrics and Gynecology departments at Indira Gandhi Institute of Medical Sciences, Patna, for a year (October 2021 to September 2022) due to obstetric difficulties resulting in acute renal damage. The study included 62 patients with a mean age of 25.08±4.25 years. The majority of patients in our study were aged 18-25 years (38, 61.3%), followed by 26-30 years (19, 30.6%) and >30 years (5, 8.1%). The majority of patients in our study were non-booked (52, 83.9%) and presented as emergency cases, whereas 10 (16.1%) patients had booked. In addition, 34 (54.8%) patients were primigravida, while 28 (45.1%) were multigravida. There were 25 patients in their third trimester (40.3%), 19 who were postpartum (30.6%), 10 who were post-abortion (16.1%), and eight in their second trimester (12.9%). Upon admission, the majority of the patients showed signs of oliguria, accounting for 45 cases (72.6%). This was followed by nine cases of abnormal kidney function (14.5%) and eight cases of anuria (12.9%). Among the other symptoms, fever was observed in 25 cases (40.32%), whereas breathlessness increased to 15 cases (24.19%), edema was present in 14 cases (22.58%), vomiting and altered sensorium were observed in four cases (6.45%), abdominal pain was observed in three cases (4.83%), and burning micturition was observed in two cases (3.22%). The most common causes of AKI in pregnancy in the present study were puerperal sepsis (18 cases, 29.0%), followed by preeclampsia/eclampsia (14 cases, 22.6%), hemorrhagic shock (10 cases, 16.1%), septic abortion (six cases, 9.7%), hyperemesis gravidarum (four cases, 6.5%), acute fatty liver of pregnancy (three cases, 4.8%), disseminated intravascular coagulation (three cases, 4.8%), drug-induced sepsis (two cases, 3.2%), and urosepsis (two cases, 3.2%). Modes of delivery in this study were normal vaginal delivery (32 cases, 51.6%), lower segment cesarean section (21 cases, 33.9%), dilation and evacuation (seven cases, 11.3%), and total hysterectomy (two cases, 3.2%). Hemodialysis was performed in 39 patients (62.9%), and 51 (82.3%) received blood transfusions. The mean systolic and diastolic BP (mmHg) were 111.37±22.60 and 71.40±18.88, respectively. Maternal outcome data revealed that 48 (77.4%) women had fully recovered, eight (12.9%) had not recovered, 43 (69.4%) were lost to follow-up, and two (3.2%) had died. Neonatal outcomes in the present study were as follows: live birth, 43 (69.4%); abortion, eight (12.9%); intrauterine death of the fetus, five (8.1%); and neonatal mortality, six (9.7%). The diagnosis and treatment of AKI during pregnancy is a significant challenge for the treating physician because of the pathophysiological changes that occur during pregnancy, the variability of symptoms, and the fact that clinical and laboratory features may occasionally overlap.

Liver imaging and pregnancy: what to expect when your patient is expecting.

Liver diseases in pregnancy can be specific to gestation or only coincidental. In the latter case, the diagnosis can be difficult. Rapid diagnosis of maternal-fetal emergencies and situations requiring specialized interventions are crucial to preserve the maternal liver and guarantee materno-fetal survival. While detailed questioning of the patient and a clinical examination are highly important, imaging is often essential to reach a diagnosis of these liver diseases and lesions. Three groups of liver diseases may be observed during pregnancy: (1) diseases related to pregnancy: intrahepatic cholestasis of pregnancy, pre-eclampsia, eclampsia, hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, and acute fatty liver of pregnancy; (2) liver diseases that are more frequent during or exacerbated by pregnancy: acute herpes simplex hepatitis, Budd-Chiari syndrome, hemorrhagic hereditary telangiectasia, hepatocellular adenoma, portal vein thrombosis, and cholelithiasis; (3) coincidental conditions, including acute hepatitis, incidental focal liver lesions, metabolic dysfunction-associated steatotic liver disease, cirrhosis, hepatocellular carcinoma, liver abscesses and parasitosis, and liver transplantation. Specific knowledge of the main imaging findings is required to reach an early diagnosis, for adequate follow-up, and to avoid adverse consequences in both the mother and the fetus.Critical relevance statement Pregnancy-related liver diseases are the most important cause of liver dysfunction in pregnant patients and, in pregnancy, even common liver conditions can have an unexpected turn. Fear of radiations should never delay necessary imaging studies in pregnancy.Key points• Pregnancy-related liver diseases are the most frequent cause of liver dysfunction during gestation.• Fear of radiation should never delay necessary imaging studies.• Liver imaging is important to assess liver emergencies and for the diagnosis and follow-up of any other liver diseases.• Common liver conditions and lesions may take an unexpected turn during pregnancy.• Pregnancy-specific diseases such as pre-eclampsia and HELLP syndrome must be rapidly identified. However, imaging should never delay delivery when it is considered to be urgent for maternal-fetal survival.

Poor perinatal outcome in a woman with severe pre-eclampsia and asymptomatic COVID-19

There is currently little known about the complex interaction between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and pregnancy. Past data from MERS-CoV and SARS-CoV-1 indicated that infection was associated with an adverse neonatal outcome. A 20-year-old primigravida presented at 23 weeks gestation and was found to have severe pre-eclampsia complicated by HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) and acute fatty liver of pregnancy (AFLP). She had no respiratory symptoms and only one documented elevated body temperature from the referring facility. She was subsequently found to be COVID-19 positive. Within several hours of admission, she had an intrauterine demise. Following delivery, her condition steadily improved. COVID-19 may worsen pre-eclampsia leading to an adverse outcome. Obstetricians should be aware of the possible negative impact of COVID-19 on hypertensive disorders of pregnancy and the need for further research on this complex relationship.

Factors and a model to predict three-month mortality in patients with acute fatty liver of pregnancy from two medical centers

BackgroundAcute fatty liver of pregnancy (AFLP) is an uncommon but potentially life-threatening complication. Lacking of prognostic factors and models renders prediction of outcomes difficult. This study aims to explore factors and develop a prognostic model to predict three-month mortality of AFLP.MethodsThis retrospective study included 78 consecutive patients fulfilling both clinical and laboratory criteria and Swansea criteria for diagnosis of AFLP. Univariate and multivariate cox regression analyses were used to identify predictive factors of mortality. Predictive efficacy of prognostic index for AFLP (PI-AFLP) was compared with the other four liver disease models using receiver operating characteristic (ROC) curve.ResultsAFLP-related three-month mortality of two medical centers was 14.10% (11/78). International normalised ratio (INR, hazard ratio [HR] = 3.446; 95% confidence interval [CI], 1.324–8.970), total bilirubin (TBIL, HR = 1.005; 95% CI, 1.000-1.010), creatine (Scr, HR = 1.007; 95% CI, 1.001–1.013), low platelet (PLT, HR = 0.964; 95% CI, 0.931–0.997) at 72 h postpartum were confirmed as significant predictors of mortality. Artificial liver support (ALS, HR = 0.123; 95% CI, 0.012–1.254) was confirmed as an effective measure to improve severe patients’ prognosis. Predictive accuracy of PI-AFLP was 0.874. Area under the receiver operating characteristic curves (AUCs) of liver disease models for end-stage liver disease (MELD), MELD-Na, integrated MELD (iMELD) and pregnancy-specific liver disease (PSLD) were 0.781, 0.774, 0.744 and 0.643, respectively.ConclusionTBIL, INR, Scr and PLT at 72 h postpartum are significant predictors of three-month mortality in AFLP patients. ALS is an effective measure to improve severe patients’ prognosis. PI-AFLP calculated by TBIL, INR, Scr, PLT and ALS was a sensitive and specific model to predict mortality of AFLP.

Management strategies on acute fatty liver in pregnancy: the Malaysian experience of liver transplantation in an obstetric emergency

Management strategies on acute fatty liver in pregnancy: the Malaysian experience of liver transplantation in an obstetric emergency

Clinical analysis of 86 cases of acute fatty liver of pregnancy

Objective: To investigate the clinical characteristics and maternal and fetal prognosis of pregnant women with acute fatty liver of pregnancy (AFLP). Methods: The clinical data of 86 AFLP pregnant women admitted to the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to August 2022 were collected, and their general data, clinical characteristics, laboratory tests and maternal and fetal outcomes were retrospectively analyzed. Results: (1) General information: the age of the 86 pregnant women with AFLP was (30.8±5.4) years, and the body mass index was (21.0±2.5) kg/m2. There were 50 primiparas (58.1%, 50/86) and 36 multiparas (41.9%, 36/86). There were 64 singleton pregnancies (74.4%, 64/86) and 22 twin pregnancies (25.6%, 22/86). (2) Clinical characteristics: the main complaints of AFLP pregnant women were gastrointestinal symptoms, including epigastric pain (68.6%, 59/86), nausea (47.7%, 41/86), anorexia (46.5%, 40/86), vomiting (39.5%, 34/86). The main non-gastrointestinal symptoms were jaundice of skin and/or scleral (54.7%, 47/86), edema (38.4%, 33/86), fatigue (19.8%, 17/86), bleeding tendency (16.3%, 14/86), polydipsia or polyuria (14.0%, 12/86), skin itching (8.1%, 7/86), and 17.4% (15/86) AFLP pregnant women had no obvious symptoms. (3) Laboratory tests: the incidence of liver and kidney dysfunction and abnormal coagulation function in AFLP pregnant women was high, and the levels of blood ammonia, lactate dehydrogenase and lactic acid were increased, and the levels of hemoglobin, platelet and albumin decreased. However, only 24 cases (27.9%, 24/86) of AFLP pregnant women showed fatty liver by imageology examination. (4) Pregnancy outcomes: ① AFLP pregnant women had a high incidence of pregnancy complications, mainly including renal insufficiency (95.3%, 82/86), preterm birth (46.5%, 40/86), hypertensive disorders in pregnancy (30.2%, 26/86), gestational diabetes mellitus (36.0%, 31/86), fetal distress (24.4%, 21/86), pulmonary infection (23.3%, 20/86), disseminated intravascular coagulation (16.3%, 14/86), multiple organ dysfunction syndrome (16.3%, 14/86), hepatic encephalopathy (9.3%, 8/86), and intrauterine fetal death (2.3%, 2/86). ② Treatment and outcome of AFLP pregnant women: the intensive care unit transfer rate of AFLP pregnant women was 66.3% (57/86). 82 cases were improved and discharged after treatment, 2 cases were transferred to other hospitals for follow-up treatment, and 2 cases (2.3%, 2/86) died. ③ Neonatal outcomes: except for 2 cases of intrauterine death, a total of 106 neonates were delivered, including 39 cases (36.8%, 39/106) of neonatal asphyxia, 63 cases (59.4%, 63/106) of neonatal intensive care unit admission, and 3 cases (2.8%, 3/106) of neonatal death. Conclusions: AFLP is a severe obstetric complication, which is harmful to mother and fetus. In the process of clinical diagnosis and treatment, attention should be paid to the clinical manifestations and laboratory tests of pregnant women, early diagnosis and active treatment, so as to improve maternal and fetal outcomes.

Waitlist and posttransplant outcomes of pregnancy-related acute liver failure in the United States.

Data on the liver transplant (LT) outcomes of women with acute liver failure (ALF) due to liver diseases unique to pregnancy (P-ALF) are limited. Using United Network of Organ Sharing (UNOS) data (1987-2021), we analyzed waitlist and post-LT outcomes of ALF in women of childbearing age comparing P-ALF versus ALF due to liver diseases not unique to pregnancy. Baseline characteristics were compared between groups at the time of listing for LT. Of 3542 females aged 16-43 years and listed for LT for ALF, 84 (2%) listed for P-ALF were less likely to be Black (11 vs. 21%, p =0.033), have lower international normalized ratio (2.74 vs. 4.53 p <0.002), but more likely to have respiratory failure (56% vs. 41%, p <0.005), be on pressors (58% vs. 43%, p <0.005), and require dialysis (23% vs. 10%, p <0.001). The cumulative 90-day waitlist mortality (WLM) was lower in P-ALF vs. ALF due to liver diseases not unique to pregnancy (7.4 vs. 16.6%, p <0.001). Posttransplant survival rates at 5 years were similar (82% vs. 79%, p =0.89). In a Fine and Gray regression model controlled for listing year and Model for End-Stage Liver Disease score, 90-day WLM was lower in P-ALF with a sub-HR of 0.42 (95% CI: 0.19-0.94, p =0.035). Of 84 women with P-ALF and listed for LT, 45 listed for hemolysis-elevated liver enzymes-low platelets (HELLP) versus 39 for acute fatty liver of pregnancy had higher 90-day WLM (19.3% vs. 5.7% p <0.005). The 90-day WLM was about 10-fold higher in HELLP versus acute fatty liver of pregnancy with a sub-HR of 9.97 (95% CI: 1.64-60.55, p =0.013). In this UNOS database analysis of ALF among women of childbearing age, the waitlist outcome is better in women with P-ALF compared to women with ALF due to liver diseases not unique to pregnancy. Among women with P-ALF, the 90-day WLM is worse for HELLP versus acute fatty liver of pregnancy. Further studies are needed to improve the management of HELLP and prevent the development of ALF in this subgroup population.

Labor and delivery: DIC, HELLP, preeclampsia.

Hematologists are often needed to assist with the management of microangiopathic emergencies in pregnancy. A firm understanding of the diagnosis and management of preeclampsia with severe features, hemolysis elevated liver enzyme and low platelet syndrome, and disseminated intravascular coagulation, which are the most common causes of microangiopathic emergencies, is critical. However, being able to consider when other microangiopathic emergencies (acute fatty liver of pregnancy, congenital and acquired thrombotic thrombocytopenic purpura, complement mediated microangiopathy, antiphospholipid syndrome) should be considered is imperative. The hematologist and obstetric team should work together to optimize the care of common as well as rare hematologic emergencies.

A Twin Pregnant Woman Presented with Jaundice in the Third Trimester Complicated by Acute Fatty Liver of Pregnancy

&lt;p&gt;妊娠急性脂肪肝是一種發生在妊娠晚期罕見但致命性的疾病，一旦發病直接威脅到孕婦與胎兒的生命安全。本案例是一位31歲雙胞胎孕婦，在妊娠36週+3天出現食慾不振、噁心嘔吐、右上腹痛及黃疸現象，隨後發生胎兒窘迫需盡快生產，經緊急剖腹順利產下二名男嬰，產後轉加護病房照顧。此病症依據臨床症狀、妊娠週數、實驗室數據，經排除相關疾病並應用Swansea criteria診斷為妊娠急性脂肪肝，在提供支持性治療，肝功能逐漸回復正常，病況穩定順利出院。因此，一旦高度懷疑或確立為妊娠急性脂肪肝，均須盡快終止妊娠，避免病情驟然加劇，導致進一步肝功能衰竭，以降低雙方併發症和死亡率。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening complication occurring in the third trimester. It is often fatal to both mother and fetus. This case is a 31-year-old pregnant woman with twins who developed loss of appetite, nausea and vomiting, right upper quadrant pain and jaundice before 37 weeks of gestation, followed by fetal distress and needed to be delivered as soon as possi-ble. Two male babies were successfully delivered by emergency caesarean section and the patient was transferred to the intensive care unit after delivery. Based on clinical symptoms, gestational weeks, and laboratory data, acute fatty liver of pregnancy was diagnosed by excluding related diseases and applying Swansea criteria evaluation. After providing supportive treatments, the liver function gradu-ally returned to normal, and the condition was stable, and the patient was then discharged. Therefore, once acute fatty liver of pregnancy is highly suspected or established, the pregnancy must be terminat-ed as soon as possible to avoid the sudden aggravation of the condition and lead to further liver failure, so as to reduce further complications and mortality rates.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Two DeLIVERies and a transplant: Case report of acute fatty liver of pregnancy requiring liver transplant.

Two DeLIVERies and a transplant: Case report of acute fatty liver of pregnancy requiring liver transplant.

Risk factors in patients with acute fatty liver of pregnancy: the role of abortion, total bilirubin and serum creatinine.

Acute fatty liver of pregnancy (AFLP) is a relatively rare obstetric emergency usually accompanied by fatal complications. Numerous studies have evaluated the potential risk factors for outcomes in patients with AFLP. But rare studies evaluated the predictive ability, sensitivity and specificity of the risk factors for maternal mortality. Thus, in this multicenter research, we aimed to further prove the predictive ability of the MELD model, investigated the prognostic value of history of abortion (HOA), total bilirubin (TBiL) and serum creatinine (SCr) and explored new predictive models for predicting maternal mortality in patients with AFLP. We performed a retrospective cohort study of 133 hospitalised patients with AFLP in four Chinese tertiary hospitals between January 2009 and April 2014. The maximal AUC amongst three independent risk factors for maternal death was TBiL with a cut-off point of > 131.9μmol/L, showing a sensitivity of 100% and a specificity of 55.9%. The threshold of the RF model for maternal mortality was -1.629 and the AUC was 0.876, with an 81.8% sensitivity and an 80.2% specificity. The AUC for MELD model to predict maternal death was 0.894, and the best cut-off point was 28 with a sensitivity of 81.8% and a specificity of 84.7%. Both the MELD model and the RF model showed good efficacy in predicting the maternal mortality in patients with ALFP (AUC = 0.894 and 0.876, respectively).

Perinatal Outcomes in Patients with Acute Fatty Liver of Pregnancy

Perinatal Outcomes in Patients with Acute Fatty Liver of Pregnancy

THU473 Acute Hypercalcemia In The Setting Of Acute Fatty Liver Of Pregnancy, A Case Report

Abstract Disclosure: M. Ahmad: None. M. Mack: None. A. Arif: None. L.A. Tejada: None. U. Siddiqui: None. Introduction: Hypercalcemia in pregnancy is rare and often goes unrecognized due to the overlapping symptoms of hypercalcemia and pregnancy. The most common cause of hypercalcemia in pregnant patients is primary hyperparathyroidism, with malignancy, milk alkali syndrome and familial hypocalciuric hypercalcemia being less common. Additionally, endogenous PTHrP production by breast and placental tissue have also been described as rare causes of hypercalcemia in pregnancy. We describe an interesting case of severe hypercalcemia in a pregnant woman presenting with acute fatty liver of pregnancy (AFLP) which rapidly corrected after delivery. Case description: The patient was a 32-year-old female with a past medical history of hypothyroidism and type 2 diabetes mellitus who presented to the emergency department at 32 weeks gestation due to four days of nausea, vomiting and epigastric pain. The patient’s vital signs were as follows: blood pressure: elevated to 133/79 mmHg, heart rate: 75 beats per minute, temperature: 36.7 C, and respiratory rate: 12 breaths per minute. On physical exam, the patient had diffuse abdominal tenderness with no vaginal bleeding. The patient’s blood work was significant for: bicarbonate: 17 mmol/L, creatinine: 1.26 mg/dL (baseline 0.7 mg/dL), corrected calcium of 15.1 mg/dL, ALP: 438 IU/L, AST: 653 IU/L, ALT: 666IU/L, total bilirubin: 2.3 mg/dL, INR 1.3, and ammonia: 43 mcmol/L. She was taken to the operating room for emergent cesarian delivery for concerns of AFLP. Further workup of the patient’s hypercalcemia, revealed a low normal PTH level of 11 pg/dL (normal 11-65 mg/dL), PTHrP level of &amp;lt;5 mg/dL, TSH of 1.37 uIU/ml, 25-OH vitamin D 55 ng/ml, and 1,25-OH vitamin D: 20 pg/ml. After delivery, the patient had alleviation of her symptoms and was kept on dextrose 5% with lactated ringers at 100 cc/h for a total of two days and had complete resolution of her hypercalcemia (corrected calcium of 10.2 mg/dL on discharge). The patient follows with endocrinology as an outpatient and since has had normal calcium levels. Discussion: Hypercalcemia in pregnancy is rare, only affecting 0.03% of women in the reproductive age group, with primary hyperparathyroidism being the most common cause. Hypercalcemia in pregnancy can often be missed due to the hemodilution of serum calcium in pregnancy and also the nonspecific symptoms present in pregnant patients. Our case describes a patient presentation of severe hypercalcemia with AFLP, who had rapid correction of her calcium levels after delivery. The exact mechanism of her severe hypercalcemia developed remains unclear, however, given its rapid resolution with delivery of the placenta potential etiologies include the AFLP itself or possibly the placenta contributing to hypercalcemia. Through this case report, we hope to highlight a possible association between AFLP and hypercalcemia. Presentation: Thursday, June 15, 2023

Acute Fatty Liver of Pregnancy - A Rare but Fatal Obstetric Complication

Acute Fatty Liver of Pregnancy - A Rare but Fatal Obstetric Complication