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The association between aspartate aminotransferase (AST) to platelets (PLT) ratio (APRI) and the development of intrahepatic cholestasis in pregnancy and other related complications

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To assess the association between aspartate aminotransferase (AST) to platelet count ratio index (APRI score), during the first and third trimesters of pregnancy and the development of intrahepatic cholestasis in pregnancy (ICP).

Methods

Case–control study was conducted. The study included patients diagnosed with ICP by elevated bile acids (n = 118) and a control group of women with symptoms such as elevated liver enzymes or pruritus with normal level of bile acids (n = 127) who attended a large tertiary teaching medical center between the years 2014 and 2021. The groups were compared in terms of obstetrical characteristics, perinatal outcomes, first- and third-trimester laboratory tests, and APRI scores during the first and third trimester. A receiver operating characteristic (ROC) analysis was performed to determine the APRI score cutoff value that could predict ICP.

Results

The third-trimester APRI scores of patients with ICP were significantly higher than those of the control group (P < 0.001). The ROC analysis revealed that the cutoff value for the APRI score was 0.42 with 65.3% sensitivity and 73.2% specificity.

Conclusion

Our results suggest that the third-trimester APRI score is positively associated with ICP.

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Data availability

According to Helsinki approval of the study, data availability is unavailable.

References

  1. Manzotti C, Casazza G, Stimac T, Nikolova D, Gluud C (2019) Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy. Cochrane Database Syst Rev 7:CD012546

  2. Geenes V, Williamson C (2009) Intrahepatic cholestasis of pregnancy. World J Gastroenterol 15(17):2049–2066

    Article  PubMed  PubMed Central  Google Scholar 

  3. Floreani A, Gervasi MT (2016) New insights on intrahepatic cholestasis of pregnancy. Clin Liver Dis [Internet] 20(1):177–189. Available from: https://doi.org/10.1016/j.cld.2015.08.010

  4. Kremer AE, Oude Elferink RPJ, Beuers U (2011) Pathophysiology and current management of pruritus in liver disease. Clin Res Hepatol Gastroenterol 35(2):89–97

    Article  CAS  PubMed  Google Scholar 

  5. Tribe RM, Dann AT, Kenyon AP, Seed P, Shennan AH, Mallet A (2010) Longitudinal profiles of 15 serum bile acids in patients with intrahepatic cholestasis of pregnancy. Am J Gastroenterol [Internet] 105(3):585–595. Available from: https://doi.org/10.1038/ajg.2009.633

  6. Mannes GA, Stellaard F, Paumgartner G (1987) Diagnostic sensitivity of fasting and postprandial serum bile acids determined by different methods. Clin Chim Acta 162(2):147–154

    Article  CAS  PubMed  Google Scholar 

  7. Mitchell AL, Ovadia C, Syngelaki A, Souretis K, Martineau M, Girling J et al (2021) Re-evaluating diagnostic thresholds for intrahepatic cholestasis of pregnancy: case–control and cohort study. BJOG An Int J Obstet Gynaecol 128(10):1635–1644

    Article  CAS  Google Scholar 

  8. Ovadia C, Seed PT, Sklavounos A, Geenes V, Di Illio C, Chambers J et al (2019) Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet 393(10174):899–909

    Article  PubMed  PubMed Central  Google Scholar 

  9. Levanony O, Sheiner E, Kluwgant D, Pariente G (2023) Maternal term pruritus and long-term neuropsychiatric hospitalizations of the offspring. Arch Gynecol Obstet 308(3):857–862

    Article  PubMed  Google Scholar 

  10. Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS et al (2003) A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 38(2):518–526

    Article  PubMed  Google Scholar 

  11. Singal AG, Thomassen LV, Gretch DR, Shuhart MC (2011) Use of the AST to platelet ratio index in HCV/HIV co-infected patients. Aliment Pharmacol Ther 33(5):566–577

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Tolunay HE, Kahraman NÇ, Varlı EN, Ergani SY, Obut M, Çelen Ş et al (2021) First-trimester aspartate aminotransferase to platelet ratio index in predicting intrahepatic cholestasis in pregnancy and its relationship with bile acids: a pilot study. Eur J Obstet Gynecol Reprod Biol 256:114–117

    Article  CAS  PubMed  Google Scholar 

  13. Kirbas A, Biberoglu E, Daglar K, Iskender C, Erkaya S, Dede H et al (2014) Neutrophil-to-lymphocyte ratio as a diagnostic marker of intrahepatic cholestasis of pregnancy. Eur J Obstet Gynecol Reprod Biol 180(1):12–15

    Article  PubMed  Google Scholar 

  14. Tolunay HE, Kahraman NC, Varli EN, Reis YA, Celen S, Turhan A (2021) Can first-trimester AST to platelet ratio index scores predict HELLP syndrome? 31(02):188–192

  15. Cui D, Zhong Y, Zhang L, Du H (2017) Bile acid levels and risk of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy: A meta-analysis. J Obstet Gynaecol Res 43(9):1411–1420

    Article  CAS  PubMed  Google Scholar 

  16. Garcia-Flores J, Cañamares M, Cruceyra M, Garicano A, Espada M, Lopez A, Tamarit I (2015) Clinical value of maternal bile acid quantification in intrahepatic cholestasis of pregnancy as an adverse perinatal outcome predictor. Gynecol Obstet Invest 79:222–228

    Article  CAS  PubMed  Google Scholar 

  17. Bicocca MJ, Sperling JD, Chauhan SP (2018) Intrahepatic cholestasis of pregnancy: review of six national and regional guidelines. Eur J Obstet Gynecol Reprod Biol [Internet] 231:180–187. Available from: https://doi.org/10.1016/j.ejogrb.2018.10.041

  18. Pekin O (2017) Can we predict severity of intrahepatic cholestasis of pregnancy using inflammatory markers ? Enflamatuvar belirteçleri kullanarak gebelik kolestazının 4:160–165

    Google Scholar 

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Razan Saadi, Alla Saban, Adi Y. Weintraub & Tamar Eshkoli

  2. Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    David Yardeni

Authors
  1. Razan Saadi
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  2. Alla Saban
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  3. Adi Y. Weintraub
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Contributions

RS—data collection and manuscript writing. AS—data analysis. AYW—manuscript editing. DY—manuscript editing. TE—project development and manuscript editing. All authors contributed to the study conception and design. Data collection and analysis were performed by RS, AS, and TE. The first draft of the manuscript was written by Razan Saadi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Razan Saadi.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Soroka University Medical Center (#0253-21-SOR).

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An informed consent was not needed due to the retrospective nature of the research.

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Saadi, R., Saban, A., Weintraub, A.Y. et al. The association between aspartate aminotransferase (AST) to platelets (PLT) ratio (APRI) and the development of intrahepatic cholestasis in pregnancy and other related complications. Arch Gynecol Obstet (2024). https://doi.org/10.1007/s00404-024-07383-8

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