HELLP [hemolysis, elevated liver enzymes and low platelet count] syndrome versus severe preeclampsia: a critical care comparative study

ABSTRACT

We performed this study to assess the clinical spectrum and evaluate the outcome of patients with HELLP-syndrome compared to those with severe preeclampsia but without HELLP managed in the intensive care unit [ICU]. Serum albumin level was measured as a prognostic factor. A prospective clinical and laboratory study that was conducted over 18 months period where sixty seven preecalmptic postpartum women admitted to ICU were studied, and were divided into 2 groups. Group I, 21 patients with HELLP-syndrome, and group II, 46 patients with severe preeclampsia only were compared and contrasted concerning medical and laboratory data. Patients in group-I were older than group II [28.7 +/- 6.6 vs 24.5 +/- 4.6, P < 0.05] and-had higher medical complications than patients in group-I I. Eclampsia 62% vs 20% [odds-ratio = 5.95% C1 = 1.2-20.6, P < 0.01], adult respiratory distress syndrome [ARDS] with respiratory failure 29% vs 4% [odds-ratio=l2.4, 95% CI - 1.2-126.1, p<0.01], multiorgan failure [MOF] 43% vs.4% [odds-ratio = 8.4, 95% CI = 1.4-52,. p<0.01] and mortality 38% vs.7% [odds-ratio=11.6, 95%, CI= 1.9-70.2, p<0.01] respectively. There was no significant difference between both groups concerning disseminated intravascular coagulation [DIC] and circulatory failure. Serum albumin on admission was significantly lower in HELLP syndrome patients [2.2 +/- 0.6 gm/dl] than patients with severe preeclampsia [2.8 +/- 0.6 gm/dI, P < 0.01]. Serum albumin correlated significantly with both MOF [t-value = 2.7, DF = 40, P=0.01] and mortality [t-value = 3.7, DF = 27, p = 0.001]. Preecalmptic patients with HELLP-syndrome are amenable for serious medical complications and higher mortality rate than patients with severe preeclampsia but no HELLP. Serum albumin is lower in patients with HELLP-syndrome and correlates well with the development of MOF and mortality so can be used as a useful predictor of both morbidity and mortality in critically ill preecalmptic patients