Elevated liver enzymes and adverse outcomes among patients with preeclampsia with severe features

Figures & data

Figure 1. Flow diagram for study inclusion.

LFTs, liver function tests.

^aExcluded patients with chronic hypertension with superimposed preeclampsia who did not meet criteria for preeclampsia with severe features.

^bBased on OHSU lab values, where an AST ≥82 U/L and an ALT ≥120 U/L are considered two times the upper limit of normal or above threshold LFTs.

Table 1. Adverse maternal and neonatal outcomes among patients with preeclampsia with severe features^a stratified by elevated liver enzymes pre-delivery.

	Above threshold LFTs^b (n = 44)	Normal LFTs^b (n = 275)	p^c
Adverse maternal outcomes
Blood transfusion	7 (16)	15 (5)	.011
Eclampsia	0 (0)	5 (2)	>.99
Intensive care unit (ICU) admission	3 (7)	12 (4)	.45
Liver infarction or rupture^d	1 (2)	0 (0)	.14
Stroke	0 (0)	1 (0)	>.99
Oliguria	1 (2)	8 (3)	>.99
Vision loss	0 (0)	1 (0)	>.99
Cardiomyopathy	0 (0)	1 (0)	>.99
Placental abruption	3 (7)	6 (2)	.11
Composite adverse maternal outcome (any of above)	9 (20)	42 (15)	.38
Adverse neonatal outcomes
Neonatal intensive care unit (ICU) admission	30 (68)	142 (52)	.041
Neonatal intubation	5 (11)	20 (7)	.35
Respiratory Distress Syndrome	18 (41)	69 (25)	.029
Very low birth weight <1500 g	9 (20)	30 (11)	.073
5-minute Apgar score <7	8 (18)	33 (12)	.26
Arterial cord pH <7	0 (0)	5 (2)	>.99
Stillbirth	0 (0)	1 (0)	>.99
Neonatal demise	1 (2)	7 (3)	>.99
Neonatal seizure	0 (0)	0 (0)	>.99
Bronchopulmonary dysplasia	1 (2)	1 (0)	.26
Necrotizing enterocolitis	0 (0)	2 (1)	>.99
Intraventricular hemorrhage	2 (5)	3 (1)	.14
Hypoxic ischemic encephalopathy	0 (0)	3 (1)	>.99
Retinopathy of prematurity	5 (11)	12 (4)	.055
Neonatal sepsis	1 (2)	1 (0)	.26
Composite adverse neonatal outcome (any of above)	31 (70)	147 (53)	.035

^aIncludes those with preeclampsia with severe features in addition to HELLP syndrome, and chronic hypertension with superimposed preeclampsia (who meet criteria for preeclampsia with severe features).

Data are listed as n (%) unless otherwise specified.

^bBased on OHSU lab values, where an AST ≥82 U/L and an ALT ≥120 U/L are considered two times the upper limit of normal or above threshold LFTs.

^cChi-squared or Fisher’s exact test (categorical data).

^dOne case of suspected liver rupture was diagnosed by RUQ ultrasound.