Reduced portal vein blood flow velocity in acute fatty liver of pregnancy

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Abstract

Purpose

Acute fatty liver of pregnancy (AFLP) is a severe complication that can occur in the third trimester or immediately postpartum, characterized by rapid hepatic failure. This study aims to explore the changes in portal vein blood flow velocity and liver function during pregnancy, which may assist in the early diagnosis and management of AFLP.

Methods

This longitudinal study was conducted at a tertiary healthcare center with participants recruited from routine antenatal check-ups. The study included healthy women aged 20–40 years with singleton pregnancies. Doppler ultrasonography was used to assess portal vein flow and velocity, complemented by standard laboratory tests to monitor liver function. A nomogram model integrating the clinical features and Doppler ultrasonography parameters was constructed using logistic regression analysis for differentiating AFLP from normal controls.

Results

A total of 135 women were enrolled, divided into control and AFLP groups. The AFLP group demonstrated a significant reduction in portal vein flow velocity and alterations in liver dimensions. Laboratory tests indicated elevated liver enzymes and altered lipid profiles in the AFLP group. Statistical analysis showed that portal vein flow velocity could be a sensitive marker for predicting liver dysfunction in AFLP. The area under the receiver operating characteristic (ROC) curves (AUC) of the nomogram model were 0.88 (95% confidence interval [CI]: 0.82–0.95) with specificity, sensitivity, negative predictive value, and positive predictive value of 67.8, 95.0, 95.0, and 67.8, respectively, in the training cohort and 0.86 (95% CI: 0.72–0.98) and 86.9, 75.0, 83.3, and 80.0 in the test cohort, respectively. The calibration curves demonstrated good agreement between the predicted and observed probability for predicting AFLP.

Conclusion

The study underscores the potential of using portal vein flow velocity as an early diagnostic marker for AFLP in pregnant women. Further research is required to establish standardized diagnostic thresholds for portal vein flow measurements.

Related collections

Most cited references 21

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The diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: a meta-analysis

Anneloes Bohte, Jochem van Werven, Shandra Bipat … (2010)

Objective To meta-analyse the diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis. Methods From a comprehensive literature search in MEDLINE, EMBASE, CINAHL and Cochrane (up to November 2009), articles were selected that investigated the diagnostic performance imaging techniques for evaluating hepatic steatosis with histopathology as the reference standard. Cut-off values for the presence of steatosis on liver biopsy were subdivided into four groups: (1) >0, >2 and >5% steatosis; (2) >10, >15 and >20%; (3) >25, >30 and >33%; (4) >50, >60 and >66%. Per group, summary estimates for sensitivity and specificity were calculated. The natural-logarithm of the diagnostic odds ratio (lnDOR) was used as a single indicator of test performance. Results 46 articles were included. Mean sensitivity estimates for subgroups were 73.3–90.5% (US), 46.1–72.0% (CT), 82.0–97.4% (MRI) and 72.7–88.5% (1H-MRS). Mean specificity ranges were 69.6–85.2% (US), 88.1–94.6% (CT), 76.1–95.3% (MRI) and 92.0–95.7% (1H-MRS). Overall performance (lnDOR) of MRI and 1H-MRS was better than that for US and CT for all subgroups, with significant differences in groups 1 and 2. Conclusion MRI and 1H-MRS can be considered techniques of choice for accurate evaluation of hepatic steatosis. Electronic supplementary material The online version of this article (doi:10.1007/s00330-010-1905-5) contains supplementary material, which is available to authorized users.

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Intestinal Virome Signature Associated With Severity of Nonalcoholic Fatty Liver Disease

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Predictive analytics with ensemble modeling in laparoscopic surgery: A technical note

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All references

Author and article information

Contributors

Yang Zhao: Role:

Er-ke Zhang: Role:

Dan-Hua Li: Role:

Yu-Jing Zhou: Role:

Hui Jiang: Role:

Xiao-Chao Jia: URI : http://loop.frontiersin.org/people/2860404/overviewRole:

Chuan Qin: Role:

Journal

Journal ID (nlm-ta): Front Med (Lausanne)

Journal ID (iso-abbrev): Front Med (Lausanne)

Journal ID (publisher-id): Front. Med.

Title: Frontiers in Medicine

Publisher: Frontiers Media S.A.

ISSN (Electronic): 2296-858X

Publication date (Electronic): 23 December 2024

Publication date Collection: 2024

Volume: 11

Electronic Location Identifier: 1506340

Affiliations

[1] ¹Department of Medical Ultrasound, Jinshan Hospital of Fudan University , Shanghai, China

[2] ²Department of Medical Ultrasound, The Central Hospital of Karamay , Karamay, China

Author notes

Edited by: Cristina Secosan, Victor Babes University of Medicine and Pharmacy, Romania

Reviewed by: Zhongheng Zhang, Sir Run Run Shaw Hospital, China

Ling Yang, Hebei University of Engineering, China

*Correspondence: Xiao-Chao Jia, jiaxiaochao2020@ 123456163.com

Chuan Qin, qinchuan@ 123456fudan.edu.cn

Article

DOI: 10.3389/fmed.2024.1506340

PMC ID: 11701050

PubMed ID: 39764553

SO-VID: 68f2e7b4-6008-4310-8d56-c8cf68b25ffd

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 04 October 2024

Date accepted : 06 December 2024

Page count

Figures: 5, Tables: 1, Equations: 0, References: 21, Pages: 9, Words: 5056

Funding

The authors declare that financial support was received for the research, authorship, and/or publication of this article. This research was funded by Jinshan Hospital of Fudan University (ZDXK-2024-4, JSZK2023H02, and 202340204).

Custom metadata

section-at-acceptance Obstetrics and Gynecology

Keywords: acute fatty liver of pregnancy,portal vein flow velocity,liver function,doppler ultrasonography,prenatal care

Data availability:

Keywords: acute fatty liver of pregnancy, portal vein flow velocity, liver function, doppler ultrasonography, prenatal care