Clinical characteristics and prognostic factors of 39 cases with acute fatty liver in pregnancy at different termination time

Abstract

Abstract: Objective To analyze the clinical features and ultrasonic manifestations of patients with acute fatty liver in pregnancy (AFLP) at different termination time. Methods The clinical data of 39 patients with AFLP in our hospital information system between January 2019 and June 2024 were collected. According to the time of termination of pregnancy, AFLP patients were divided into delayed group and immediate group. The clinical data of the two groups were compared, and the similarities and differences of ultrasonic performance between the two groups were analyzed. Results The clinical symptoms of AFLP patients include digestive tract symptoms in 28 cases (71.8%), yellow staining of skin and sclera in 18 cases (46.1%), edema in 15 cases (38.5%), fatigue in 8 cases (20.5%) and skin itching in 3 cases (7.7%), among which the main symptoms are digestive tract symptoms, including nausea and vomiting in 24 cases (61.5%) and upper respiratory tract symptoms. In addition, complications of HELLP patients include pregnancy-induced hypertension in 5 cases (12.8%), preeclampsia in 4 cases (10.2%), gestational diabetes in 6 cases (15.4%), renal insufficiency in 30 cases (76.9%), hepatic encephalopathy in 3 cases (7.7%), multiple organ dysfunction syndrome in 5 cases (12.8%). After admission, liver protection treatment was selected according to the condition, and the delayed group was prolonged as far as possible (n=30), and the rest were immediately terminated (n=9). Comparing the clinical data, the differences of hepatic encephalopathy, PLT, TBil, Scr, INR, MELD and PI-AFLP between the two groups were statistically significant (P<0.05). All AFLP patients showed varying degrees of increase in liver volume and uneven liver echo, which was related to fat deposition in the liver. In addition to the ultrasonic manifestations of liver, the ultrasonic manifestations of AFLP patients with different clinical outcomes are mainly in extrahepatic organs. The ultrasonic changes of gallbladder, pancreas, spleen, kidney and chest cavity in patients with AFLP were summarized. By comparing the ultrasonic manifestations of delayed group and immediate group, it was found that the number of cases with poor or no bile filling, splenomegaly and pleural effusion in immediate group was significantly higher than that in delayed group (P<0.05). Conclusion There are significant differences in PLT, TBil, INR, MELD score and PI-AFLP index in different termination time of AFLP patients. At the same time, the ultrasonic manifestations of AFLP patients with immediate termination of pregnancy are poor or no bile, splenomegaly and pleural effusion, which provide basis for early identification of high-risk patients and improvement of treatment plan.

Key words: Acute fatty liver of pregnancy, Termination time, Ultrasound

LIU Si, HE Hui. Clinical characteristics and prognostic factors of 39 cases with acute fatty liver in pregnancy at different termination time[J]. Chinese Hepatolgy, 2025, 30(7): 992-995.

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