Hematological Markers: Testing a new diagnostic modality for Intrahepatic Cholestasis of pregnancy

Background: Intrahepatic Cholestasis of pregnancy (ICP) is the most common pregnancy specific liver disorder presenting usually in the 3^rd trimester with unexplained pruritis, elevated serum bile acids and/or raised liver enzymes. ICP is associated with adverse perinatal outcomes. Serum total bile acids (TBA) are considered as a gold standard for diagnosis of ICP but are time consuming, expensive and not readily available everywhere. Neutrophil to Lymphocyte ratio (NLR), Mean Platelet Volume (MPV) and Red cell Distribution Width (RDW) are haematological inflammatory markers and are routinely available on a simple complete blood count test when asked for.

Aims: To study the role of haematological inflammatory markers in Intrahepatic Cholestasis of Pregnancy (ICP) and their association with the severity of the disease.

Methods: This prospective case-control study was done in a tertiary care setting in New Delhi, from January 2021- August 2022(20 months) wherein 82 women with ICP were recruited after a written and informed consent. NLR, MPV, RDW and TBA levels were done. 82 healthy women with uncomplicated pregnancies served as the control group.

Results: Both cases & controls were comparable in terms of sociodemographic characteristics. Mean TBA levels were 22.85+/-7.82 in mild cases(60 subjects) & 66.20+/-26.97 (22 severe cases). Cases delivered earlier between 37–38 weeks. Majority of women delivered vaginally & was statistically significant. Cases developed more fetal distress(42.7% vs 9.8%) NLR and MPV were significantly raised (p<0.05) while RDW was lower in cases. The cut off for NLR & MPV were statistically significant.

Conclusion: MPV can serve as a good screening tool, a high sensitivity (95.1%) while NLR can serve as a confirmatory test as it has high specificity (96.3%) to make diagnosis of ICP, although further exploration with larger multicentric studies is required.