Acoustic radiation force impulse to measure liver stiffness and predict hepatic decompensation in pregnancy with cirrhosis: A cohort study |
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| Affiliation: | 1. Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Egypt;2. Department of Internal Medicine, Salem Medical Center and Center for Alcohol Research and Liver Disease, University of Heidelberg, Germany;3. Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt;4. Gynecology and Obstetrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt;1. Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt;2. Department of Microbial Biotechnology, Biotechnology Research Institute, National Research Centre, Giza, Egypt;3. Department of Pharmacy, Al-Mustaqbal University College, Babylon, Iraq;4. Clinical Pharmacy unit, Badr University Hospital, Helwan University, Egypt;1. Department of General Surgery, Cerrahpasa Medical Faculty, ?stanbul University- Cerrahpasa, ?stanbul, Turkey;2. Department of Pathology, Cerrahpasa Medical Faculty, ?stanbul University- Cerrahpasa, ?stanbul, Turkey;1. Department of Microbiology, Islamic Azad University, Lahijan Branch, Iran;2. Department of Microbiology, Zanjan University of Medical Sciences, Zanjan, Iran;3. Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran;4. Department of Microbiology, Guilan University of Medical Sciences, Rasht, Iran;1. Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan;2. Department of Nursing, Osaka City University Hospital, Japan |
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| Abstract: | Background and study aimsPregnancy in association with cirrhosis is a rather uncommon and highly risky situation for both mother and child. We aim to study all factors and the utility of liver stiffness (LS) measurement by Acoustic Radiation Force Impulse elastography (ARFI) to predict hepatic decompensation in pregnant cirrhotic patients.Patients and methodsWe prospectively recruited 224 pregnant women at the multidisciplinary clinic of liver disease with pregnancy, Cairo University. LS was measured using ARFI (Siemens ACUSON S3000 ultrasound system) during the second trimester and 8–12 weeks post-delivery. The outcome of pregnancy and the incidence of hepatic decompensation were assessed.ResultsOur cohort comprised 128 normal pregnancies, 37 patients with pregnancy-related liver disease (Intrahepatic cholestasis (n = 6), preeclampsia (n = 23), and hyperemesis gravidarum (n = 8)) and 59 patients with an established chronic liver disease not related to pregnancy. In all patients, LS significantly decreased after delivery from 1.19 m/s to 0.94 m/s (P < 0.001). In multivariate analysis, LS was an independent predictor for the outcome of pregnancy in all patients (odds ratio (OR) = 5.442 (3.01–6.82), cut-off = 1.21 m/s). Patients with cirrhosis, mean LS was 1.57 ± 0.66 m/s and 26 (44%) patients had hepatic decompensation (hepatocellular jaundice (n = 8), ascites (n = 9) and variceal bleeding (n = 6)). In multivariate analysis; LS, platelets, albumin, and bilirubin were independent predictors of decompensation post-delivery and the OR for LS was 6.141(4.32–7.98). The optimal cut off value of LS to predict decompensation was 1.46 m/s (8.4 kPa) with AUROC of 0.827.ConclusionLS can be used to predict hepatic decompensation after delivery in pregnant women with manifest cirrhosis. |
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| Keywords: | Acoustic radiation force impulse (ARFI) Elastography Hepatic decompensation Pregnant cirrhotic patients Liver diseases with pregnancy |
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