Risk Factors for Maternal and Fetal Mortality in Acute Fatty Liver of Pregnancy and New Predictive Models.
Risk Factors for Maternal and Fetal Mortality in Acute Fatty Liver of Pregnancy and New Predictive Models.
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妊娠期急性脂肪肝孕产妇和胎儿死亡的危险因素和新的预测模型
DOI：
10.3389/fmed.2021.719906
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发表时间：
2021
影响因子：
3.9
通讯作者：
Wang C
中科院分区：
文献类型：
--
作者：
Meng Z;Fang W;Meng M;Zhang J;Wang Q;Qie G;Chen M;Wang C
急性妊娠脂肪肝（AFLP）是一种罕见但可能危及生命的肝脏疾病，可导致相当多的孕产妇和胎儿死亡率。为探讨AFLP产妇和胎儿死亡的危险因素并建立新的预测模型，我们通过回顾性研究分析了106例在山东省立医院就诊的AFLP患者的人口学特征、临床症状和实验室检查结果。采用单因素和多因素logistic回归分析对孕产妇和胎儿死亡的危险因素进行分析。在AFLP中对基于多变量logistic回归分析的新模型和终末期肝病（MELD）模型进行检验。采用受试者工作特征曲线（ROC）比较两种模型的预测效率、敏感性和特异性。产前恶心（p = 0.037）、凝血酶原时间延长（p = 0.003）、血清肌酐升高（p = 0.003）是孕产妇死亡的独立危险因素。ROC曲线显示，MELD的曲线下面积（AUC）为0.948，灵敏度为100%，特异性为83.3%。该模型的AUC为0.926，灵敏度为90%，特异性为94.8%。肝性脑病（p = 0.016）和血小板减少症（p = 0.001）是胎儿死亡的独立危险因素。使用ROC曲线，MELD的AUC为0.694，敏感性为68.8%，特异性为64.4%。该模型的AUC为0.893，敏感性为100%，特异性为73.3%。新的产妇死亡率预测模型和MELD对AFLP患者产妇死亡率的预测效果均较好（AUC分别为0.926和0.948），新的胎儿死亡率预测模型对胎儿死亡率的预测效果优于MELD （AUC分别为0.893和0.694）。这两种新的预测模型更容易获得，更便宜，更容易在临床上实施，特别是在低收入国家。
Acute fatty liver of pregnancy (AFLP) is a rare but potentially life-threatening hepatic disorder that leads to considerable maternal and fetal mortality. To explore the risk factors for maternal and fetal mortality in AFLP and develop new predictive models, through this retrospective study, we analyzed the demographic characteristics, clinical symptoms, and laboratory findings of 106 patients with AFLP who were admitted to Shandong Provincial Hospital. Risk factors for maternal and fetal mortality were analyzed by univariate and multivariate logistic regression analysis. The new models based on the multivariate logistic regression analysis and the model for end-stage liver disease (MELD) were tested in AFLP. The receiver operating characteristic curve (ROC) was applied to compare the predictive efficiency, sensitivity, and specificity of the two models. Prenatal nausea (p = 0.037), prolonged prothrombin time (p = 0.003), and elevated serum creatinine (p = 0.003) were independent risk factors for maternal mortality. The ROC curve showed that the area under the curve (AUC) of the MELD was 0.948, with a sensitivity of 100% and a specificity of 83.3%. The AUC of the new model for maternal mortality was 0.926, with a sensitivity of 90% and a specificity of 94.8%. Hepatic encephalopathy (p = 0.016) and thrombocytopenia (p = 0.001) were independent risk factors for fetal mortality. Using the ROC curve, the AUC of the MELD was 0.694, yielding a sensitivity of 68.8% and a specificity of 64.4%. The AUC of the new model for fetal mortality was 0.893, yielding a sensitivity of 100% and a specificity of 73.3%. Both the new predictive model for maternal mortality and the MELD showed good predictive efficacy for maternal mortality in patients with AFLP (AUC = 0.926 and 0.948, respectively), and the new predictive model for fetal mortality was superior to the MELD in predicting fetal mortality (AUC = 0.893 and 0.694, respectively). The two new predictive models were more readily available, less expensive, and easier to implement clinically, especially in low-income countries.
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影响因子：
24.5
作者：
Knight, M.;Nelson-Piercy, C.;Brocklehurst, P.
通讯作者：
Brocklehurst, P.
影响因子：
4.3
作者：
Xiong, Hao-Feng;Liu, Jing-Yuan;Li, Xing-Wang
通讯作者：
Li, Xing-Wang
影响因子：
81.5
作者：
Christ-Crain, Mirjam;Bichet, Daniel G.;Verkman, Alan S.
通讯作者：
Verkman, Alan S.
DOI：
10.1080/14767058.2016.1269316
发表时间：
2017-01-01
影响因子：
1.8
作者：
Wang, Shan;Li, Shan-Ling;Wang, Xie-Tong
通讯作者：
Wang, Xie-Tong
影响因子：
5.6
作者：
Natarajan SK;Ibdah JA
通讯作者：
Ibdah JA