The effect of Hepatitis B Viral Infection on Hemostatic Profile and Liver markers in Ghanaian Pregnant Women

Abstract

<title>Abstract</title> Background Viral hepatitis has been associated with profound alterations in the coagulation system as well as liver biomarkers. Meanwhile, during pregnancy, the coagulation system also undergoes significant changes with an increase in the majority of the clotting factors and a decrease in natural anticoagulants. This study aimed to evaluate the coagulation profile and liver biomarkers among hepatitis B-infected pregnant women in a Ghanaian population. Methods This case-control study was conducted with 90 hepatitis B pregnant women as cases and 90 hepatitis B negative pregnant women as controls. A structured questionnaire was used to obtain sociodemographic, obstetric, and clinical data from each participant. Results Levels of albumin, Fibrinogen [4.09 (3.57–5.94) vs. 6.89 (5.43–9.08), p &lt; 0.0001], Protein C [2.46 (1.09–3.42) vs. 4.12 (2.96–6.07), p &lt; 0.0001], and Protein S [2.61 (2.20–3.36) vs. 2.98 (2.53–3.54), p = 0.036] were significantly reduced in the hepatitis B positive pregnant women than the negative controls. However, there was high levels of AST, ALP and bilirubins in hepatitis B positive pregnant women than the controls. Also, Protein C and Protein S had significantly positive association with PT and aPTT, whereby a rise in Protein C and Protein S, resulted in an increasing PT and aPTT respectively (all p-value &lt; 0.05). Conversely, albumin had a negative correlation with both PT and aPTT (p-value &lt; 0.05). In a ROC analysis, aPTT had the highest area under the curve (AUC) value (AUC = 0.881) and the optimal clotting time at which aPTT indicated chronic hepatitis B was ≥ 35.7secs with sensitivity of 79.4% and specificity of 91.6%. Conclusion Pregnant women with hepatitis B infection present with significant changes in their coagulation parameters, natural anticoagulants and liver biomarkers. Furthermore, Fibrinogen, Protein C, and aPTT showed accurate diagnostic potential in identifying chronic viral hepatitis B infection and may be valuable surrogate indicators for managing chronic hepatitis-related complications.