TY - JOUR
T1 - The clinical importance of early acute hepatic porphyria diagnosis
T2 - a national cohort
AU - Edel, Yonatan
AU - Mamet, Rivka
AU - Cohen, Sharon
AU - Shepshelovich, Daniel
AU - Levi, Assi
AU - Sagy, Iftach
N1 - Publisher Copyright:
© 2020, Società Italiana di Medicina Interna (SIMI).
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Acute hepatic porphyria (AHP) attacks begin with abdominal pain and can progress to severe life-threatening conditions. Early diagnosis and treatment may prevent these complications. We investigated the difference between the severity of porphyria attacks before and after porphyria diagnosis. A retrospective study including AHP patients hospitalized for an acute attack in Israel during a 15-year period. Diagnosis of an attack was based on typical clinical symptoms accompanied by at least one documented elevated urinary porphobilinogen above fourfold of normal values. The primary outcome was intensive care unit (ICU) admissions. Secondary outcomes included the length of hospital stay, severe hyponatremia, seizures, and psychiatric symptoms. 42 attacks in 9 patients were included. Most attacks occurred in women (78.6%) and in acute intermittent porphyria patients (76.2%). The mean age of attack was 26.5 (± 6.3) years. Attacks following porphyria diagnosis had a lower prevalence of ICU admission (3.3% versus 75.0%, p < 0.001), seizures (0% versus 50.0%, p < 0.001), psychiatric symptoms (23.3% versus 66.7%, p = 0.01), severe hyponatremia (16.7% versus 83.3%, p < 0.001), and median length of hospital stay (5 versus 11.0 days, p < 0.001). These results remained significant after simple univariate logistic regression for ICU admission [odds ratio (OR) 0.01, 95% confidence interval (CI) 0.00–0.12], prolonged hospital stay (OR 0.08, 95% CI 0.01–0.41), seizures or neurological symptoms (OR 0.06, 95% CI 0.01–0.30), and severe hyponatremia (OR 0.02, 95% CI 0.00–0.20). Previously diagnosed AHP patients have a significantly milder attack course as compared to previously undiagnosed patients. Family screening following sentinel cases might prevent severe AHP attacks.
AB - Acute hepatic porphyria (AHP) attacks begin with abdominal pain and can progress to severe life-threatening conditions. Early diagnosis and treatment may prevent these complications. We investigated the difference between the severity of porphyria attacks before and after porphyria diagnosis. A retrospective study including AHP patients hospitalized for an acute attack in Israel during a 15-year period. Diagnosis of an attack was based on typical clinical symptoms accompanied by at least one documented elevated urinary porphobilinogen above fourfold of normal values. The primary outcome was intensive care unit (ICU) admissions. Secondary outcomes included the length of hospital stay, severe hyponatremia, seizures, and psychiatric symptoms. 42 attacks in 9 patients were included. Most attacks occurred in women (78.6%) and in acute intermittent porphyria patients (76.2%). The mean age of attack was 26.5 (± 6.3) years. Attacks following porphyria diagnosis had a lower prevalence of ICU admission (3.3% versus 75.0%, p < 0.001), seizures (0% versus 50.0%, p < 0.001), psychiatric symptoms (23.3% versus 66.7%, p = 0.01), severe hyponatremia (16.7% versus 83.3%, p < 0.001), and median length of hospital stay (5 versus 11.0 days, p < 0.001). These results remained significant after simple univariate logistic regression for ICU admission [odds ratio (OR) 0.01, 95% confidence interval (CI) 0.00–0.12], prolonged hospital stay (OR 0.08, 95% CI 0.01–0.41), seizures or neurological symptoms (OR 0.06, 95% CI 0.01–0.30), and severe hyponatremia (OR 0.02, 95% CI 0.00–0.20). Previously diagnosed AHP patients have a significantly milder attack course as compared to previously undiagnosed patients. Family screening following sentinel cases might prevent severe AHP attacks.
KW - Diagnosis
KW - Intensive care
KW - Porphobilinogen
KW - Porphyria
UR - http://www.scopus.com/inward/record.url?scp=85085141531&partnerID=8YFLogxK
U2 - 10.1007/s11739-020-02359-3
DO - 10.1007/s11739-020-02359-3
M3 - Article
C2 - 32372331
AN - SCOPUS:85085141531
SN - 1828-0447
VL - 16
SP - 133
EP - 139
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
IS - 1
ER -