A prediction model for hemolysis, elevated liver enzymes and low platelets syndrome in pre-eclampsia with severe features.
HELLP syndrome
prediction model
pre‐eclampsia with severe features
risk factors
Journal
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
ISSN: 1879-3479
Titre abrégé: Int J Gynaecol Obstet
Pays: United States
ID NLM: 0210174
Informations de publication
Date de publication:
09 Aug 2024
09 Aug 2024
Historique:
revised:
28
07
2024
received:
03
06
2024
accepted:
30
07
2024
medline:
9
8
2024
pubmed:
9
8
2024
entrez:
9
8
2024
Statut:
aheadofprint
Résumé
The aim of the present study was to determine the risk factors for patients with pre-eclampsia (PE) with severe features to develop hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and to design a prediction score model that incorporates these risk factors. A retrospective cohort study was conducted at a tertiary university-affiliated medical center between 2011 and 2019. The study population comprised patients diagnosed with PE with severe features, divided into two groups: those with HELLP syndrome (study group) and those without (control group). A logistic regression was employed to identify independent predictors of HELLP syndrome. A predictive model for the occurrence of HELLP syndrome in the context of PE with severe features was developed using a receiver operating characteristic curve analysis. Overall, 445 patients were included, of whom 69 patients were in the study group and 376 in the control group. A multivariate logistic analysis regression showed that maternal age <40 (OR = 2.28, 95% CI: 1.13-5.33, P = 0.045), nulliparity (OR = 2.22, 95% CI: 1.14-4.88, P = 0.042), mild hypertension (OR = 2.31, 95% CI: 1.54-4.82, P = 0.019), epigastric pain (OR = 3.41, 95% CI: 1.92-7.23, P < 0.001) and placental abruption (OR = 6.38, 95% CI: 1.29-35.61, P < 0.001) were independent risk factors for HELLP syndrome. A prediction score model reached a predictive performance with an area under the curve of 0.765 (95% CI: 0.709-0.821). This study identified several key risk factors for developing HELLP syndrome among patients with PE with severe features and determined that a prediction score model has the potential to aid clinicians in identifying high risk patients.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Références
Steegers EAP, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre‐eclampsia. Lancet. 2010;376(9741):631‐644.
Yang Y, Le Ray I, Zhu J, Zhang J, Hua J, Reilly M. Preeclampsia prevalence, risk factors, and pregnancy outcomes in Sweden and China. JAMA Netw Open. 2021;4(5):e218401.
Sibai B, Dekker G, Kupferminc M. Pre‐eclampsia. Lancet. 2005;365(9461):785‐799.
Martin JN, Rinehart BK, May WL, Magann EF, Terrone DA, Blake PG. The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification. Am J Obstet Gynecol. 1999;180(6 Pt 1):1373‐1384.
Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004;103(5 Pt 1):981‐991.
Turgut A, Demirci O, Demirci E, Uludoğan M. Comparison of maternal and neonatal outcomes in women with HELLP syndrome and women with severe preeclampsia without HELLP syndrome. J Prenat Med. 2010;4(3):51‐58.
Maged AM, Elsherief A, Hassan H, et al. Maternal, fetal, and neonatal outcomes among different types of hypertensive disorders associating pregnancy needing intensive care management. J Matern Fetal Neonatal Med. 2020;33(2):314‐321.
Fitzpatrick KE, Hinshaw K, Kurinczuk JJ, Knight M. Risk factors, management, and outcomes of hemolysis, elevated liver enzymes, and low platelets syndrome and elevated liver enzymes, low platelets syndrome. Obstet Gynecol. 2014;123(3):618‐627.
Lisonkova S, Razaz N, Sabr Y, et al. Maternal risk factors and adverse birth outcomes associated with HELLP syndrome: a population‐based study. BJOG. 2020;127(10):1189‐1198.
Malmström O, Morken N‐H. HELLP syndrome, risk factors in first and second pregnancy: a population‐based cohort study. Acta Obstet Gynecol Scand. 2018;97(6):709‐716.
ACOG. Gestational hypertension and preeclampsia: ACOG practice bulletin, number 222. Obstet Gynecol. 2020;135(6):e237‐e260.
Tran S, Fogel J, Karrar S, Hong P. Comparison of process outcomes, clinical symptoms and laboratory values between patients with antepartum preeclampsia, antepartum with persistent postpartum preeclampsia, and new onset postpartum preeclampsia. J Gynecol Obstet Hum Reprod. 2020;49(5):101724.
Dollberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon E‐S. Birth weight standards in the live‐born population in Israel. Isr Med Assoc J. 2005;7(5):311‐314.
Saftlas AF, Beydoun H, Triche E. Immunogenetic determinants of preeclampsia and related pregnancy disorders: a systematic review. Obstet Gynecol. 2005;106(1):162‐172.
Dekker GA, Robillard PY, Hulsey TC. Immune maladaptation in the etiology of preeclampsia: a review of corroborative epidemiologic studies. Obstet Gynecol Surv. 1998;53(6):377‐382.
Bdolah Y, Elchalal U, Natanson‐Yaron S, et al. Relationship between nulliparity and preeclampsia may be explained by altered circulating soluble fms‐like tyrosine kinase 1. Hypertens Pregnancy. 2014;33(2):250‐259.
van Lieshout LCEW, Koek GH, Spaanderman MA, van Runnard Heimel PJ. Placenta derived factors involved in the pathogenesis of the liver in the syndrome of haemolysis, elevated liver enzymes and low platelets (HELLP): a review. Pregnancy Hypertens. 2019;18:42‐48.
Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol. 1993;169(4):1000‐1006.
Rimaitis K, Grauslyte L, Zavackiene A, Baliuliene V, Nadisauskiene R, Macas A. Diagnosis of HELLP syndrome: a 10‐year survey in a perinatology centre. Int J Environ Res Public Health. 2019;16(1):109.
Audibert F, Friedman SA, Frangieh AY, Sibai BM. Clinical utility of strict diagnostic criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Am J Obstet Gynecol. 1996;175(2):460‐464.
Vinnars M‐T, Wijnaendts LCD, Westgren M, Bolte AC, Papadogiannakis N, Nasiell J. Severe preeclampsia with and without HELLP differ with regard to placental pathology. Hypertension. 2008;51(5):1295‐1299.
Lind Malte A, Uldbjerg N, Wright D, Tørring N. Prediction of severe pre‐eclampsia/HELLP syndrome by combination of sFlt‐1, CT‐pro‐ET‐1 and blood pressure: exploratory study. Ultrasound Obstet Gynecol. 2018;51(6):768‐774.
Li Z, Dai Y, Yun L, Guo W. A prediction model for the progression from gestational hypertension to pre‐eclampsia complicated with HELLP syndrome. Int J Gynaecol Obstet. 2023;165:1002‐1012.