title: Liver function tests in viremic and nonviremic chronic hepatitis B virus-infected pregnant women: importance of alanine aminotransferase/sodium ratio.
abstract: The major risk factor of perinatal transmission of Hepatitis B virus (HBV) infection is the level of maternal HBV-deoxyribonucleic acid (DNA) during the third trimester of pregnancy. The primary aim of this study was to evaluate the hematological and biochemical status in Hepatitis B e-antigen (HBeAg)-negative chronic HBV-infected pregnant women and to correlate the findings with the presence or absence of viremia. Ninety-five consecutive chronic HBV-infected pregnant women were evaluated between the 28th and 32nd week of gestation. Viral load was determined by using the COBAS TaqMan HBV test. Sixty-nine women were evaluated and 14 of them exhibited HBV-DNA levels higher than 2000 IU·ml. In this study, viremic women exhibited significantly higher alanine aminotransferase (ALT), creatinine, and uric acid values as well as significantly lower white blood cell count compared with nonviremic women. There was also a significant statistical difference concerning ALT/sodium ratio between viremic and nonviremic women (0.20 ± 0.22 vs. 0.10 ± 0.09, respectively, p= .024). The optimal cutoff points discriminating those women with a high probability to have detectable serum HBV-DNA were 0.092 for ALT/sodium ratio (sensitivity = 73.0%, specificity = 61.5%, area under the receiver operating characteristic curve [AUC] = 71.05%) and 12.8 IU/L for ALT (sensitivity = 73.0%, specificity = 63.0%, AUC = 72.2%). Chronic HBV-infected pregnant women with ALT/sodium ratio ≥ 0.11 had the higher probability of having serum HBV-DNA levels higher than 2000 IU/ml (sensitivity = 76.92%, specificity = 58%, AUC = 62.38%). Presence of HBV-DNA in maternal blood during the third trimester of pregnancy is significantly associated with maternal serum ALT levels in HBeAg-negative chronic HBV-infected pregnant women. Women with an ALT/sodium ratio greater than 0.092 have the higher probability of HBV-DNA presence in maternal blood whereas an ALT/sodium ratio greater than 0.11 could discriminate those women with HBV-DNA levels higher than 2000 IU/ml.
authors.affiliation: Ioannis S. Elefsiniotis, PhD, MD, is Assistant Professor, University Department of Internal Medicine-Hepatology Unit, Elena Venizelou Hospital, Athens, Greece. Konstantinos Tsoumakas, PhD, MD, is Associate Professor, University Department of Pediatrics, Faculty of Nursing, Athens, Greece. Maria Kapritsou, PhD, MSc, BSN, RN, is Registered Nurse, Hellenic Anticancer Institute, Saint Savvas Hospital, Athens, Greece. Ioanna Magaziotou, PhD(c), RN, is Pediatrician, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece. Angeliki Derdemezi, PhD, MSc, RN, is Registered Nurse, University Department of Pediatrics, Faculty of Nursing, Athens, Greece. Mariolis-Sapsakos T. PhD, MD, is Lecturer in Anatomy, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece. Evangelos A. Konstantinou, PhD, MSc, RN, is Associate Professor of Nursing Anaesthesiology, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Ioannis S
authors.initials: IS
authors.lastname: Elefsiniotis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsoumakas
authors.forename: Maria
authors.initials: M
authors.lastname: Kapritsou
authors.forename: Ioanna
authors.initials: I
authors.lastname: Magaziotou
authors.forename: Angeliki
authors.initials: A
authors.lastname: Derdemezi
authors.forename: Mariolis-Sapsakos
authors.initials: MS
authors.lastname: T
authors.forename: Th
authors.initials: T
authors.lastname: Katsoulas
authors.forename: Evangelos A
authors.initials: EA
authors.lastname: Konstantinou
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood / Q000821:virology*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008111:Liver Function Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000821:virology*; D011263:Pregnancy Trimester, Third; D012964:Sodium / Q000097:blood*; D014766:Viremia / Q000097:blood / Q000821:virology*
chemical_list: D004279:DNA, Viral; D012964:Sodium; D000410:Alanine Transaminase