Blood scores may help with ICP diagnosis, management: Study

Two scores calculated from blood biomarkers can accurately discriminate between pregnant women with intrahepatic cholestasis of pregnancy (ICP) and those without, and predict ICP-associated complications, according to a study from Moldova.

“This study provides valuable information to help clinicians better diagnose and perform the management of intrahepatic cholestasis of pregnancy,” the researchers wrote.

The study, “Assessment of aspartate aminotransferase to Platelet Ratio Index and Fibrosis-4 Index score on women with intrahepatic cholestasis of pregnancy,” was published in AJOG Global Reports.

ICP, the most common pregnancy-related liver complication, is a specific form of cholestasis — a condition marked by stalled bile flow — that typically occurs during the third trimester of pregnancy. Bile is a fluid produced in the liver that normally flows to the small bowel to help break down fatty foods. Cholestasis leads to bile accumulation in the liver, affecting its function, and bile acids leakage into the bloodstream, causing symptoms such as severe itchiness.

ICP is associated with an increased risk of adverse fetal outcomes, including preterm birth, abnormalities in the amniotic fluid that surrounds the baby in the womb, and stillbirth.

Noninvasive tests diagnose liver scarring, damage

ICP is diagnosed by measuring bile acid levels in the blood and checking how well the liver is working based on blood levels of the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) liver enzymes.

A liver biopsy, in which a small piece of the liver is surgically removed for examination, “is the most specific test to assess the nature and severity of liver condition,” the researchers wrote. But the test carries serious risks.

Noninvasive tests, including the AST to Platelet Ratio Index (APRI) and the Fibrosis-4 Index (FIB-4), may be used to diagnose and predict how fast liver scarring and damage are progressing. However, whether these two scores can be used to diagnose and monitor ICP remains largely unclear.

APRI is calculated based on AST levels and the number of platelets in the blood, whereas FIB-4 is calculated using a formula that takes into account the patient’s age, AST and ALT levels, and platelets counts. Platelets are the tiny blood cell fragments that promote blood clotting.

The team of researchers in Moldova assessed APRI and FIB-4 in 71 pregnant women with mild or severe ICP, based on their clinical symptoms and bile acid levels, and 71 healthy pregnant women, who served as a control group.

Women with ICP were a mean 2.2 years older than those without ICP (29.5 vs. 27.3).

Results showed that the mean APRI score was four times higher in the ICP group than in the control group (1.2 vs. 0.3).

Higher APRI scores were significantly linked to higher bile acid levels, indicating more severe disease, as well as earlier deliveries and the presence of meconium — a baby’s first stool — in the amniotic fluid.

Detection of meconium in the amniotic fluid increases the chance the baby will breathe meconium into the lungs, which may cause breathing trouble.

Results point to scores as ‘important step’ in ICP diagnosis, management

The mean FIB-4 score was significantly higher in women with ICP than in those without (0.97 vs. 0.61). Higher FIB-4 scores were significantly associated with higher bile acid levels, earlier deliveries, more cesarean deliveries, and more blood loss after giving birth.

The APRI score was more accurate than the FIB-4 score in diagnosing ICP, with better specificity (92.9% vs. 78.8%) and sensitivity (66.2% vs. 57.7%). Here, sensitivity refers to the percentage of ICP cases being correctly identified, and specificity refers to the percentage of unaffected cases being correctly ruled out.

The findings suggest “that the assessment of APRI and FIB-4 scores in women with ICP is an important step in the diagnosis and management of the condition,” the researchers wrote.

Both scores “are promising markers in predicting complications related to ICP,” such as giving birth before term, passing meconium into the amniotic fluid, and losing blood after childbirth, they wrote.

However, due to the small number of patients in the study, “it is necessary to perform a study involving a larger number of participants, and other biomarkers are needed to confirm those findings,” the team wrote. Such findings “will be important in the clinical counseling of women diagnosed with ICP,” they said.

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