The clinical importance of early acute hepatic porphyria diagnosis: a national cohort

Yonatan Edel, Rivka Mamet, Sharon Cohen, Daniel Shepshelovich, Assi Levi, Iftach Sagy

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)133-139
Number of pages7
JournalInternal and Emergency Medicine
Volume16
Issue number1
DOIs
StatePublished - Jan 2021

Keywords

  • Diagnosis
  • Intensive care
  • Porphobilinogen
  • Porphyria

Fingerprint

Dive into the research topics of 'The clinical importance of early acute hepatic porphyria diagnosis: a national cohort'. Together they form a unique fingerprint.

Cite this