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Predicting mortality in patients with pregnancy-specific liver disease 

The most recent issue of the Clinical Gastroenterology & Hepatology identifies factors that predict 1-month mortality in patients with pregnancy-specific liver disease.

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Pregnancy-specific liver diseases such as acute fatty liver of pregnancy; hemolysis, elevated liver enzymes and low platelet syndrome; and preeclampsia-associated liver disease are associated with considerable morbidity and mortality.

Dr Arvind Murali and colleagues investigated the ability of the model for end-stage liver disease (MELD) to predict 1-month mortality among patients with pregnancy-specific liver diseases.

The research team also developed and tested a model to predict mortality based on features of pregnancy-specific liver diseases.

The team performed a retrospective study, analyzing hospital admission, clinical, hematologic, and biochemical data collected from 130 patients with pregnancy-specific liver diseases admitted to the St. John's Medical College Hospital (Bangalore, India) from 2000 through 2011.

Patients were followed up until 3 months after delivery or death. Logistic regression models were fitted using the MELD score and other variables identified as clinically or statistically significant.

7 of the 8 studies had a high risk of bias in at least 1 quality domain
Clinical Gastroenterology & Hepatology

The predictive accuracy and calibration of the models were assessed by receiver operating characteristic curves and the Hosmer–Lemeshow goodness-of-fit test.

The team observed that 25% of patients died.

Mortalities from pregnancy-specific liver diseases within 1 month of admission among patients with MELD scores of 20 to 29, 30 to 39, or 40 or greater were 24%, 46%, and 91%, respectively.

Univariate analysis identified encephalopathy, ascites, serum total protein, bilirubin, platelet count, alkaline phosphatase, serum creatinine, and international normalized ratio (INR) as significant variables.

Multivariate analysis identified total bilirubin and INR as significant predictors of mortality.

The researchers found that MELD score and a model based on only 2 variables accurately predicted mortality, and were well calibrated.

Dr Murali's team concluded, "A new logistic model based on only 2 variables was comparable with the MELD model in predicting mortality among women with pregnancy-specific liver diseases."

Clin Gastroenterol Hepatol 2014: 12(1): 109-113
21 January 2014

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