The utility of albumin–bilirubin score in patients with intrahepatic cholestasis of pregnancy: a retrospective comparative study

SUMMARY

OBJECTIVE:

The aim of this study was to examine the utility of the albumin–bilirubin score in cases of intrahepatic cholestasis of pregnancy.

METHODS:

A total of 413 patients (182 intrahepatic cholestasis of pregnancy, 50 suspected intrahepatic cholestasis of pregnancy, 181 healthy controls) enrolled in this study. Patients with typical pruritus and bile acid levels >10 μmol/L are defined as the intrahepatic cholestasis of pregnancy group. Patients with pruritus have the same pattern as intrahepatic cholestasis of pregnancy, but who are ultimately diagnosed with other dermatoses of pregnancy are defined as suspected intrahepatic cholestasis of pregnancy. Demographic data, laboratory parameters, and albumin–bilirubin scores were compared between three groups. Correlation analysis was performed on the albumin–bilirubin score and bile acid levels. Also, receiver operating curve analyses were performed to evaluate the predictive performance of the albumin–bilirubin score for intrahepatic cholestasis of pregnancy diagnosis.

RESULTS:

The albumin–bilirubin score of the intrahepatic cholestasis of pregnancy group was significantly higher than the other groups. A positive, weak correlation was found between the albumin–bilirubin score and bile acid levels in the intrahepatic cholestasis of pregnancy group. The receiver operating curve curve analyses showed albumin–bilirubin score has significant performance for the prediction of intrahepatic cholestasis of pregnancy in all subjects (area under the curve: 0.726, 95%CI 0.679–0.774, p<0.001) (sensitivity: 69%, specificity: 64%). The detection rate for albumin–bilirubin score was calculated as 67.3%. The positive predictive value was 3.95% (CI 2.9–5.3%), and the negative predictive value was 98.9% (CI 98.6–99.2%).

CONCLUSION:

This study indicated higher albumin–bilirubin score levels in the intrahepatic cholestasis of pregnancy group and a positive relationship between serum bile acid levels and albumin–bilirubin score. Therefore, albumin–bilirubin score could be a cost-effective liver function test for pregnant women with intrahepatic cholestasis of pregnancy.

KEYWORDS:
Albumin; Bilirubin; Intrahepatic cholestasis of pregnancy; High-risk pregnancy