A 20-year single-center experience with acute liver failure during pregnancy: Is the prognosis really worse?

✍ Scribed by Vikram Bhatia; Amit Singhal; Subrat Kumar Panda; Subrat Kumar Acharya

• Publisher: John Wiley and Sons
• Year: 2008
• Tongue: English
• Weight: 127 KB
• Volume: 48
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.22493

✦ Synopsis

Pregnant patients with acute liver failure (ALF) are believed to have a worse outcome than nonpregnant women and men with ALF. However objective data supporting this supposition are scant. Therefore, the current study compared the outcome, complications, and causes of ALF among pregnant women and girls with age-matched nonpregnant women and girls and men and boys with ALF. One thousand fifteen consecutive ALF patients in the reproductive age group, admitted at the All India Institute of Medical Sciences, New Delhi, from January 1986 to December 2006, were included in the study. A total of 249 (38.5%) women were pregnant. They were compared with 341 nonpregnant women and girls and 425 men and boys, aged 15 to 45 years. The mortality rate of pregnant women and girls (53.8%) was similar to age-matched nonpregnant women and girls (57.2%), and men and boys (57.9%); P ‫؍‬ 0.572.The clinical and biochemical features, disease severity, and complications were also similar in the three groups. A significantly higher proportion of ALF was attributable to hepatitis E virus (HEV) among women and girls who were pregnant (59.4%), as compared with both nonpregnant women and girls (30.4%), and men and boys (23.1%); P < 0.001. However, the outcome of HEV-related ALF was independent of the sex and pregnancy status of the patients (P ‫؍‬ 0.103). Mortality in HEV-ALF and non-HEV-ALF patients in pregnant women and girls was 51% (74/145) and 54.7% (52/ 95)(P > 0.1), respectively. The outcome of pregnant ALF patients was also unrelated to the trimester of pregnancy. The mortality of non-HEV-related ALF among the pregnant women and girls (54.7%), age-matched nonpregnant women and girls (61.7%), and men and boys (62.8%) were also similar (P > 0.1). Conclusion: The mortality of pregnant patients with ALF is similar to that of nonpregnant women and girls and men and boys and is independent of the cause or trimester. Pregnancy per se should not be regarded as a poor prognostic factor for a patient with ALF. (HEPATOLOGY 2008;48:1577-1585.) See Editorial on Page 1380 P regnant women with acute liver failure (ALF) are widely regarded as having a more severe disease with higher complication rates and mortality as compared with nonpregnant patients. 1,2 The highest bur-den of ALF is found in the Indian subcontinent, China, and southeast Asia, where hepatitis E virus (HEV) is the commonest cause of endemic and epidemic acute hepatitis. 1,[3][4][5][6][7] Although pregnancy does not confer increased susceptibility to hepatitis A, B, and C viruses, pregnant women may be more vulnerable to infection by HEV. During epidemics of acute non-A, non-B viral hepatitis, a high attack rate and mortality has been noted during pregnancy. [3][4][5][6] Most of these epidemics were presumably caused by HEV infection. Similar findings have also been noted in the sporadic setting, but not consistently. 7,8 Furthermore, HEV hepatitis is a more severe disease during pregnancy. [3][4][5][6] Pregnant women and girls with acute HEV hepatitis decompensate to liver failure more commonly than nonpregnant patients with acute hepatitis. [3][4][5][6] However, progression from exposure to infection, development of clinical acute hepatitis, development of liver failure, and eventual recovery or demise involves a series of differential susceptibilities of the host to the hepatic insult. Increased vulnerability to infection should not be