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How accurate are the Swansea criteria to diagnose acute fatty liver of pregnancy in predicting hepatic microvesicular steatosis?
  1. A Goel1,
  2. B Ramakrishna2,
  3. U Zachariah1,
  4. J Ramachandran1,
  5. C E Eapen1,
  6. G Kurian1,
  7. G Chandy1
  1. 1Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
  2. 2Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
  1. Correspondence to Dr C E Eapen, Department of Gastrointestinal Sciences, Christian Medical College, Vellore 632004, Tamil Nadu, India

https://doi.org/10.1136/gut.2009.198465

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    We noted that in two recent reports in Gut, none of 62 patients diagnosed by the Swansea criteria to have acute fatty liver of pregnancy (AFLP) underwent liver biopsy.1 2 We retrospectively assessed the accuracy of the Swansea criteria to predict hepatic microvesicular steatosis in 34 patients with suspected pregnancy-related liver disease who underwent liver biopsy at our centre between 1998 and 2006. These patients tested negative for other causes of acute liver dysfunction such as hepatitis viruses (hepatitis B virus surface antigen (HBsAg), hepatitis C virus (HCV) antibody, immunoglobulin (Ig) M hepatitis A virus (HAV) antibody, IgM hepatitis E virus (HEV) antibody), malarial parasite and sepsis (blood culture). No patient gave a history of ingestion of a potentially hepatotoxic drug. We excluded 10 patients (details in figure 1).

    Figure 1

    Flowchart of patients with suspected pregnancy-related liver disease who underwent liver …

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    Footnotes

    • Competing interests None.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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      Authors' response
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      Gut 2010; 60 139-139 Published Online First: 11 Oct 2010. doi: 10.1136/gut.2010.221986
    • PostScript
      Author's response
      Jeremy G C Kingham
      Gut 2010; 60 139-140 Published Online First: 11 Oct 2010. doi: 10.1136/gut.2010.222240