Liver fibrosis markers as predictors of adverse outcomes in pregnancy-related hypertensive disorders

Abstract Objectives This study aimed to compare noninvasive liver fibrosis markers, including the Aspartate Aminotransferase Platelet Ratio Index (APRI) and FIB-4, between patients with hypertensive disorders of pregnancy (HDP) and healthy controls and to investigate the association between these markers and adverse maternal and perinatal outcomes. Methods In this retrospective case-control study, 205 patients with HDP and 192 normotensive controls were included for evaluation. Demographic data, laboratory findings, and maternal and perinatal outcomes were compared. FIB-4 and APRI scores were calculated using second-trimester AST, ALT, and platelet levels. ROC curve analysis was used to assess the predictive accuracy of these indices for HELLP syndrome and other complications. Linear regression analysis was applied to evaluate the parameters associated with the FIB-4 score. Results FIB-4 and APRI scores were significantly higher in patients with HDP compared to controls (p<0.05). Among patients with severe preeclampsia and HELLP syndrome, fibrosis scores were markedly elevated. FIB-4 and APRI showed excellent diagnostic performance for HELLP syndrome (AUC: 0.976 and 0.992, respectively), with optimal cutoffs of 1.52 and 0.7. However, their predictive role for general adverse maternal and perinatal outcomes was limited. In multivariate regression, systolic blood pressure, maternal age, and adverse maternal outcomes were independent predictors of increased FIB-4 scores (p<0.05). Conclusions FIB-4 and APRI may be considered simple, noninvasive indices that could contribute to early risk stratification for HELLP syndrome among patients with HDP. Although their predictive capacity remains to be validated in larger prospective studies, they may offer preliminary insights into hepatic dysfunction during pregnancy.