title: Bile acid ratio in diagnosis of intrahepatic cholestasis of pregnancy.
abstract: We sought to determine if the bile acid ratio of cholic acid to chenodeoxycholic acid (CA:CDCA) is an important component for diagnosis of intrahepatic cholestasis of pregnancy (ICP). We assessed the addition of bile acid CA:CDCA ratio information in diagnosing ICP in a database of patients evaluated for ICP by serum bile acids and hepatic transaminases. Patients were considered to test positive for ICP if there was elevation in total bile acid, CA:CDCA ratio, or transaminase. Of 231 specimens evaluated for ICP with bile acid and transaminases, 17.1% had elevated total bile acids, 29.4% had elevated transaminase, and 8.2% had an elevated bile acid ratio. Most specimens with elevated bile acid ratio also had elevated total bile acid; 35.5% of specimens tested positive by total bile acid and/or transaminases, increasing minimally to 35.9% with bile acid ratio information. Similar results were found using lower total bile acid and bile acid ratio thresholds. The bile acid CA:CDCA ratio contributed little to the diagnosis of ICP. The use of total bile acid and hepatic transaminases without bile acid ratios decreased positive tests by less than 2%.
authors.affiliation: Department of Obstetrics and Gynecology, New York University, New York, New York, USA. wmhuang123@yahoo.com
authors.forename: William M
authors.initials: WM
authors.lastname: Huang
authors.forename: Meghana
authors.initials: M
authors.lastname: Gowda
authors.forename: James G
authors.initials: JG
authors.lastname: Donnelly
mesh_terms: D000328:Adult; D001647:Bile Acids and Salts / Q000032:analysis / Q000378:metabolism*; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008111:Liver Function Tests; D008423:Maternal Age; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000209:etiology; D011256:Pregnancy Outcome; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D000637:Transaminases / Q000032:analysis / Q000378:metabolism*; D055815:Young Adult
chemical_list: D001647:Bile Acids and Salts; D000637:Transaminases