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

• Published in: Internal and emergency medicine 2021, Vol.16 (1), p.133-139
• Main Authors: Edel, Yonatan, Mamet, Rivka, Cohen, Sharon, Shepshelovich, Daniel, Levi, Assi, Sagy, Iftach
• Format: Article
• Language: English
• Subjects: Diagnosis; Hyponatremia; Im - Original; Internal Medicine; Liver; Medical diagnosis; Medicine; Medicine & Public Health; Patients; Porphyria; Seizures
• ISSN: 1828-0447; 1970-9366
• DOI: 10.1007/s11739-020-02359-3

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