Characteristics of liver function in patients with preeclampsia

BACKGROUND: Despite a significant number of studies devoted to the problem of preeclampsia, to date, a large number of issues related to the etiology, pathogenesis, and therapy for this pathology remain far from a final solution. That is why obstetricians always face the difficult task of developing rational tactics for the management and delivery of pregnant women with preeclampsia, one has to take into account all the risks to the health of both the mother and her unborn child. Therefore, relevant is the search for the most informative methods for diagnosing liver dysfunction with an increase in the severity of preeclampsia. The hepatobiliary system is known to carry a multifunctional load during gestation and is one of the first to respond to an increase in the severity of preeclampsia. It is, therefore, crucial to choose priority biochemical parameters of blood that reflect liver function in preeclampsia, which can be used as additional criteria for making an obstetric decision in order to prevent maternal and perinatal complications.

AIM: The aim of this study was to analyze alterations in liver function in preeclampsia, in order to determine the criteria for the development of hepatic cell insufficiency as indicators of the transition to severe preeclampsia and multiple organ failure.

MATERIALS AND METHODS: This study included 123 pregnant women, of which group I (n = 40) consisted of pregnant women with preeclampsia without changes in liver function, group II (n = 33) was made up of pregnant women with preeclampsia and impaired liver function, while group III (n = 50) only comprised pregnant women with normal pregnancy. All pregnant women underwent a biochemical blood test with the determination of the parameters of cytolysis (aspartate aminotransferase, alanine aminotransferase, glutamate dehydrogenase, De Ritis ratio), cholestasis (alkaline phosphatase, total and direct bilirubin, gamma-glutamyl transpeptidase, bile acids), and hepatic cell insufficiency (cholinesterase, total protein, albumin, urea, lactate dehydrogenase), as well as a clinical blood test and coagulation tests. Pregnant women with preeclampsia were observed in the intensive care unit, with vital functions monitored.

RESULTS: The leading syndrome complex with increasing severity of preeclampsia was the cytolytic one, in which the levels of transaminases increased moderately with a predominance of alanine aminotransferase over aspartate aminotransferase activities (the De Ritis ratio was lesser than 1.0). With the development of hepatic cell insufficiency, aspartate aminotransferase activity dominated over alanine aminotransferase one (the De Ritis ratio was greater than 1.33). We also found an increase in glutamate dehydrogenase and lactate dehydrogenase activities and, among the cholestatic parameters, in the level of direct bilirubin. Hepatic cell insufficiency was characterized by a decrease in the activity of cholinesterase and decreased total protein and albumin concentrations. In the group of pregnant women with preeclampsia, we found a decrease in hemoglobin and platelet counts.

CONCLUSIONS: Altered liver function in preeclampsia reflects an increase in the severity of the pathology and indicates the development of multiple organ failure. In its terminal stage, all syndrome complexes manifest themselves as cytolytic, cholestatic and hepatic cell insufficiencies.