ESTABLISHMENT OF TRIMESTER BASED REFERENCE INTERVALS FOR SELECTED LIVER AND KIDNEY FUNCTION TESTS AMONG APPARENTLY HEALTHY PREGNANT WOMEN AT DEBRE MARKOS REFERAL HOSPITAL, NORTHWEST ETHIOPIA, 2019

Abstract

. Abstract Background: Clinical chemistry reference intervals currently in use for pregnant women in Ethiopia are adopted from text books and refer mainly Caucasian subjects. Reference intervals based on samples from non-pregnant women are not necessarily useful for clinical decisions during pregnancy due to normal changes. Therefore, establishing reference intervals during pregnancy is used to recognize normal from pathological conditions. Objective: To establish trimester based reference intervals of selected liver and kidney function tests among apparently healthy pregnant women at Debre Markos Referral Hospital, Northwest Ethiopia. Methods: Institutional based cross sectional study was conducted from March 1, 2019 to May 30, 2019, at Debere Markos Referral Hospital. This study has included 360 apparently healthy pregnant women by using convenient sampling technique. Interview based English to Amharic translated questionnaire was used to screen clinical conditions and socio-demographic characteristics. About 4 ml of blood was collected from each study participant. Laboratory tests were done using GenruiGS300plus fully automated clinical chemistry analyzer. The data were checked for completeness and entered to Epi data version 4.4.2.1, and transferred to Statistical Package for Social Sciences version 20 for analysis. The 95% reference interval was estimated by using 2.5th and 97.5th percentiles for lower and upper reference limits respectively. Kruskal Wallis one way ANOVA was applied to compare medians within trimesters. The statistically significant difference between trimesters was checked by using Post-Hoc test comparison. Results: The 95% reference interval for selected biochemical parameters was determined. The values were: for ALT(U/L): 4.00-86.92, 4.00-88.82 and 2.05-73.98, for AST(U/L): 2.00-80.98, 5.00-77.95, 4.05-83.92, for ALP (U/L): 16.82-380.98, 36.05-419.00, 33.20-555.85, for Cr (mg/dl): 0.22-0.78, 0.24- 1.20, 0.26-0.92; for urea (mg/dl): 9.03-77.00, 6.03-75.90 and 5.03-31.00 for 1st, 2nd and 3rd trimesters respectively. Conclusion and recommendation: There was large variation between results in the present study and currently in use and manufacturer provided reference values. There were also statistically significant differences within trimesters in almost for all of biochemical parameters. This shows that an establishment trimester based reference interval for patient management and interpretation of laboratory findings of the population should be based on the locally derived reference intervals. Key words: Alanine aminotransferase, Aspartate aminotransferase, Biochemical profiles, kidney function tests, Pregnancy, Reference interval, Trimester.