title: Accuracy of liver function tests for predicting adverse maternal and fetal outcomes in women with preeclampsia: a systematic review.
abstract: BACKGROUND
  Liver function tests are routinely performed in women as part of a battery of investigations to assess severity at admission and later to guide appropriate management.
  
  
  OBJECTIVE
  To determine the accuracy with which liver function tests predict complications in women with preeclampsia by a systematic review.
  
  
  METHODS
  We conducted electronic searches without language restrictions in (1951-2010), (1980-2010) and the Cochrane Library (2009).
  
  
  METHODS
  Primary articles that evaluated the accuracy of liver function tests in predicting complications in women with preeclampsia were chosen. Data was extracted by two reviewers independently. A bivariate model estimated area under the curve, sensitivity and specificity.
  
  
  RESULTS
  There were 13 primary articles including a total of 3 497 women assessing maternal (30 2×2 tables) and fetal (19 2×2 tables) outcomes. For predicting adverse maternal outcome, the point estimates of specificity were >70% in 18 tables with 0.79 (95%CI 0.51, 0.93). For predicting adverse fetal outcomes the specificity of the test was >70% in 2×2 tables. Sensitivity of the test was poor for both maternal and fetal outcomes.
  
  
  CONCLUSIONS
  In women with preeclampsia, function tests performed better in predicting adverse maternal than fetal outcomes. The presence of increased liver enzymes was associated with an increased probability of maternal and fetal complications, but normal liver enzyme levels did not rule out disease, as specificity was often higher than sensitivity.
authors.affiliation: Centre for Health Sciences, Institute of Health Sciences Education, Queen Mary University of London, London, UK. s.thangaratinam@gmail.com
authors.forename: Shakila
authors.initials: S
authors.lastname: Thangaratinam
authors.forename: Corine M
authors.initials: CM
authors.lastname: Koopmans
authors.forename: Shalini
authors.initials: S
authors.lastname: Iyengar
authors.forename: Javier
authors.initials: J
authors.lastname: Zamora
authors.forename: Khaled M K
authors.initials: KM
authors.lastname: Ismail
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
authors.forename: Khalid S
authors.initials: KS
authors.lastname: Khan
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D005333:Fetus; D006801:Humans; D007231:Infant, Newborn; D008111:Liver Function Tests; D011225:Pre-Eclampsia / Q000097:blood* / Q000378:metabolism; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase