Risk factors for acute fatty liver of pregnancy complicated by acute liver failure: a retrospective study of 133 cases.

OBJECTIVE

To investigate the clinical manifestations and trends in laboratory indices in patients with acute fatty liver of pregnancy (AFLP) and identify risk factors for AFLP complicated by acute liver failure (ALF) to improve perinatal outcomes for these patients and their infants.

METHODS

Clinical data, laboratory indices, and maternal and fetal outcomes for 133 patients with AFLP treated at our institution between January 1, 2010 and October 1, 2022 were retrospectively analyzed.

RESULTS

The most frequent clinical manifestations of AFLP were anorexia (n = 59, 44.4%), nausea (n = 41, 30.8%), and vomiting (n = 35, 26.3%). Liver function tests were significantly elevated, including serum alanine aminotransferase (287.0 ± 280.0 U/L), aspartate aminotransferase (254.0 ± 245.9 U/L), total bilirubin (99.1 ± 7.4 µmol/L), and direct bilirubin (84.3 ± 5.9 µmol/L). There was also marked coagulopathy, with a fibrinogen level of 1.7 ± 1.0 g/L and a prothrombin time of 16.7 ± 7.5 s. The main complication was acute liver failure (n = 33, 24.8%). Multivariate logistic regression analysis identified total bilirubin (OR 1.01, 95% CI 1.01-1.02, P < 0.001), direct bilirubin (OR 1.01, 95% CI 1.01-1.02, P < 0.001), prothrombin time (OR 1.20, 95% CI 1.09-1.32, P < 0.001), and activated partial thromboplastin time (OR 1.02, 95% CI 1.00-1.04, P = 0.017) to be risk factors for acute liver failure in patients with AFLP.

CONCLUSIONS

Anorexia, nausea, and vomiting were the most common clinical manifestations of AFLP. Liver dysfunction and coagulopathy were indicated by changing trends in laboratory markers. Deterioration of liver function and coagulation parameters may be risk factors for acute liver failure in AFLP. Close monitoring of liver function and coagulation in patients with suspected or confirmed AFLP is essential to prevent this potentially lethal complication.