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Preconception hepatic scores predict pregnancy outcomes in women with CLD

Preconception albumin-bilirubin score and aspartate aminotransferase to platelet ratio index accurately predicted pregnancy outcomes in women with chronic liver disease, according to recently published data.

“Preconception [albumin-bilirubin (ALBI)] score was shown to be predictive of live birth, whilst preconception [AST to platelet ratio index (APRI)] score was predictive for gestational length,” Enoka S. Gonsalkorala, MBBS, FRACP, from King’s College Hospital in London, and colleagues wrote. “In carefully selected individuals, once pregnant, liver disease does not appear to worsen significantly throughout the pregnancy nor in subsequent pregnancies.”

The researchers found 165 pregnancies in 100 women with chronic liver disease who had been seen at their institution between 1983 and 2017. Of those, 80 pregnancies occurred in 48 women with cirrhosis.

The overall live birth rate was 80%, and was not significantly different between women with cirrhosis and those without cirrhosis (75% vs. 85%). However, women with cirrhosis were significantly less likely to have a gestational length beyond 37 weeks (P = .033).

To assess the efficacy of preconception serological markers and hepatic scores as predictive measures for pregnancy outcomes, the researchers compared MELD, MELD sodium, ALBI and APRI.

Area under receiver operator curve analysis showed that ALBI (AUROC = 0.741) was superior to MELD (AUROC = 0.631), MELD sodium (AUROC = 0.673) and APRI (AUROC = 0.641) at predicting live birth. A preconception ALBI score cutoff of –2.7 had a sensitivity of 81% and specificity of 59% to predict live birth.

Similar analysis showed that APRI (AUROC = 0.7) was superior at predicting gestation beyond 37 weeks compared with MELD (AUROC = 0.579), MELD sodium (AUROC = 0.567) and APRI (AUROC = 0.629). An APRI score of 0.84 had a sensitivity of 83% and specificity of 55% for predicting gestation beyond 37 weeks.

Additionally, the researchers found that preconception counseling with a hepatologist or specialist obstetrician improved patient care. Twenty-two of 36 patients who had documented preconception counseling had cirrhosis. Women who received counseling were significantly more likely to have stable liver disease at conception than those who did not (100% vs. 86%; P = .02). They were also more likely to have undergone variceal screening endoscopy (59% vs. 32%; P = .03).

“By categorizing women using these simple hepatic scores, we have shown their value as prognostic markers of outcomes of pregnancy,” Gonsalkorala and colleagues wrote. “Preconception counseling is an opportune setting in which results of these scores can be discussed with the patient to allow informed decision making.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.