The role of inflammatory markers derived from complete blood count results in the diagnosis of intrahepatic cholestasis of pregnancy
Öz
Objective: This study aimed to investigate complete blood count (CBC) markers, particularly those indicating systemic inflammation, in healthy subjects and those with mild and severe intrahepatic cholestasis of pregnancy (ICP).
Material and Method: Seventy-nine subjects with ICP and 100 healthy age-matched women who were matched based on their scheduled singleton deliveries (on the same day) were included. ICP was defined as the increase in serum bile acid levels ≥10 μmol/L coupled with pruritus which could not be explained by other conditions. Patients with ICP were further categorized to mild and severe ICP according to bile acid levels, as follows: Mild ICP (<40 μmol/L, n=55) and severe ICP (≥40 μmol/L, n=24). Venous blood samples were drawn upon admission to analyze bile acid concentration, liver enzymes and CBC.
Results: Mean platelet volume (MPV) was similar in subjects with mild and severe ICP whose values were higher than that of controls (p<0.001). The red cell distribution width (RDW) of subjects with severe ICP was lower compared to controls, although no significant difference existed between the mild and severe ICP groups. Platelet to lymphocyte ratio (PLR) was higher in subjects with mild and severe ICP compared to controls, but it was similar in mild and severe ICP. There were no significant differences in neutrophil to lymphocyte ratio (NLR) between the groups. Correlation analysis revealed that bile acid, bilirubin, AST and ALT levels were correlated positively with MPV and PLR, and negatively with RDW value. MPV was also positively correlated with the length of stay in ICU (intensive care unit). ROC (Receiver Operating Characteristic) curve analysis showed that MPV and PLR could discriminate subjects with ICP from controls with a high sensitivity but relatively low specificity. However, neither NLR nor PLR were sensitive for discriminating severe ICP from mild ICP.
Conclusions: Some CBC derived parameters associated with inflammatory state, such as MPV and PLR, appear to have value for ICP diagnosis. However, MPV, NLR, PLR, RDW, and leukocyte count cannot be used for the discrimination of mild and severe ICP.
Anahtar Kelimeler
Destekleyen Kurum
Başakşehir Çam and Sakura City Hospital, Department of Gastroenterology
Teşekkür
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Kaynakça
- Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol 2014; 124: 120-33.
- Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol 2009; 15: 2049-66.
- Marschall HU. Management of intrahepatic cholestasis of pregnancy. Expert Review of Gastroenterol Hepatol 2015; 9: 1273-9.
- Smith DD, Rood KM. Intrahepatic cholestasis of pregnancy. Clin Obstet Gynecol 2020; 63: 134-51.
- Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology (Baltimore, Md). 2004; 40: 467-74.
- Lee RH, Kwok KM, Ingles S, et al. Pregnancy outcomes during an era of aggressive management for intrahepatic cholestasis of pregnancy. Am J Perinatol 2008; 25: 341-5.
- Ovadia C, Williamson C. Intrahepatic cholestasis of pregnancy: recent advances. Clinics in Dermatology 2016; 34: 327-34.
- Brouwers L, Koster MP, Page-Christiaens GC, et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels. Am J Obstet Gynecol 2015; 212: 100.e1-7.
- Yayla Abide Ç, Vural F, Kılıççı Ç. et al. Can we predict severity of intrahepatic cholestasis of pregnancy using inflammatory markers? Turk J Obstet Gynecol 2017; 14: 160-5.
- Dixon PH, Williamson C. The pathophysiology of intrahepatic cholestasis of pregnancy. Clinics and Research in Hepatol Gastroenterol 2016; 40: 141-53.
- Bicocca MJ, Sperling JD, Chauhan SP. Intrahepatic cholestasis of pregnancy: Review of six national and regional guidelines. Eur J Obstet Gynecol Reproductive Biology 2018; 231: 180-7.
- Floreani A, Gervasi MT. New insights on intrahepatic cholestasis of pregnancy. Clin Liver Dis 2016; 20: 177-89.
- Palmer KR, Xiaohua L, Mol BW. Management of intrahepatic cholestasis in pregnancy. Lancet (London, England) 2019; 393: 853-4.
- Wood AM, Livingston EG, Hughes BL, Kuller JA. Intrahepatic cholestasis of pregnancy: review of diagnosis and management. Obstet Gynecol Survey 2018; 73: 103-9.
- Biberoglu E, Kirbas A, Daglar K, et al. Role of inflammation in intrahepatic cholestasis of pregnancy. J Obstet Gynaecol Research 2016; 42: 252-7.
- Kirbas A, Biberoglu E, Ersoy AO, et al. The role of interleukin-17 in intrahepatic cholestasis of pregnancy. J Maternal-Fetal Neonatal Med 2016; 29: 977-81.
- Temel Yüksel İ, Aslan Çetin B, Köroğlu N, Aydoğan Mathyk B, Erdem B. Inflammatory marker YKL-40 levels in intrahepatic cholestasis of pregnancy. Gynecol Endocrinol 2019; 35: 635-7.
- Vural Yilmaz Z, Gencosmanoglu Turkmen G, Daglar K, Yılmaz E, Kara O, Uygur D. Elevated red blood cell distribution width is associated with intrahepatic cholestasis of pregnancy. Ginekologia Polska 2017; 88: 75-80.
- Kosters A, Karpen SJ. The role of inflammation in cholestasis: clinical and basic aspects. Seminars in Liver Disease 2010; 30: 186-94.
- Allen K, Jaeschke H, Copple BL. Bile acids induce inflammatory genes in hepatocytes: a novel mechanism of inflammation during obstructive cholestasis. Am J Pathol 2011; 178: 175-86.
Öz
Kaynakça
- Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol 2014; 124: 120-33.
- Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol 2009; 15: 2049-66.
- Marschall HU. Management of intrahepatic cholestasis of pregnancy. Expert Review of Gastroenterol Hepatol 2015; 9: 1273-9.
- Smith DD, Rood KM. Intrahepatic cholestasis of pregnancy. Clin Obstet Gynecol 2020; 63: 134-51.
- Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology (Baltimore, Md). 2004; 40: 467-74.
- Lee RH, Kwok KM, Ingles S, et al. Pregnancy outcomes during an era of aggressive management for intrahepatic cholestasis of pregnancy. Am J Perinatol 2008; 25: 341-5.
- Ovadia C, Williamson C. Intrahepatic cholestasis of pregnancy: recent advances. Clinics in Dermatology 2016; 34: 327-34.
- Brouwers L, Koster MP, Page-Christiaens GC, et al. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels. Am J Obstet Gynecol 2015; 212: 100.e1-7.
- Yayla Abide Ç, Vural F, Kılıççı Ç. et al. Can we predict severity of intrahepatic cholestasis of pregnancy using inflammatory markers? Turk J Obstet Gynecol 2017; 14: 160-5.
- Dixon PH, Williamson C. The pathophysiology of intrahepatic cholestasis of pregnancy. Clinics and Research in Hepatol Gastroenterol 2016; 40: 141-53.
- Bicocca MJ, Sperling JD, Chauhan SP. Intrahepatic cholestasis of pregnancy: Review of six national and regional guidelines. Eur J Obstet Gynecol Reproductive Biology 2018; 231: 180-7.
- Floreani A, Gervasi MT. New insights on intrahepatic cholestasis of pregnancy. Clin Liver Dis 2016; 20: 177-89.
- Palmer KR, Xiaohua L, Mol BW. Management of intrahepatic cholestasis in pregnancy. Lancet (London, England) 2019; 393: 853-4.
- Wood AM, Livingston EG, Hughes BL, Kuller JA. Intrahepatic cholestasis of pregnancy: review of diagnosis and management. Obstet Gynecol Survey 2018; 73: 103-9.
- Biberoglu E, Kirbas A, Daglar K, et al. Role of inflammation in intrahepatic cholestasis of pregnancy. J Obstet Gynaecol Research 2016; 42: 252-7.
- Kirbas A, Biberoglu E, Ersoy AO, et al. The role of interleukin-17 in intrahepatic cholestasis of pregnancy. J Maternal-Fetal Neonatal Med 2016; 29: 977-81.
- Temel Yüksel İ, Aslan Çetin B, Köroğlu N, Aydoğan Mathyk B, Erdem B. Inflammatory marker YKL-40 levels in intrahepatic cholestasis of pregnancy. Gynecol Endocrinol 2019; 35: 635-7.
- Vural Yilmaz Z, Gencosmanoglu Turkmen G, Daglar K, Yılmaz E, Kara O, Uygur D. Elevated red blood cell distribution width is associated with intrahepatic cholestasis of pregnancy. Ginekologia Polska 2017; 88: 75-80.
- Kosters A, Karpen SJ. The role of inflammation in cholestasis: clinical and basic aspects. Seminars in Liver Disease 2010; 30: 186-94.
- Allen K, Jaeschke H, Copple BL. Bile acids induce inflammatory genes in hepatocytes: a novel mechanism of inflammation during obstructive cholestasis. Am J Pathol 2011; 178: 175-86.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orijinal Makale |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Mart 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 5 Sayı: 2 |
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