title: HELLP syndrome is associated with an increased inflammatory response, which may be inhibited by administration of prednisolone.
abstract: OBJECTIVE
  To investigate the effect of prednisolone on HELLP syndrome by assessing several markers of the inflammatory response and hepatic damage associated with HELLP syndrome.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Single-center, tertiary obstetric care facility at the University Medical Centre Utrecht, The Netherlands.
  
  
  METHODS
  Study subjects included normal controls, patients with non-HELLP preeclampsia, and patients with preeclampsia and HELLP syndrome.
  
  
  METHODS
  HELLP syndrome was defined by hemolysis (serum lactate dehydrogenase [LDH] >600 IU/L and/or haptoglobin <or=0.3 g/L), elevated liver enzymes (serum aspartate aminotransferase [AST] >70 U/L and/or serum alanine aminotransferase [ALT] >70 U/L), and a low platelet count (<100 x 10(9)/L). Blood samples from patients with HELLP syndrome who were receiving either prednisolone or placebo were obtained before, during, and after a HELLP exacerbation in the antepartum period. Plasma levels of CRP, IL-1RA, IL-6, sIL-6R, IL-8, IL-10, TNF-alpha, and GSTA1-1 were determined. Samples from women with preeclampsia but without HELLP syndrome and from healthy pregnant women were included as controls.
  
  
  METHODS
  Plasma levels of CRP, IL-1RA, IL-6, sIL-6R, IL-8, IL-10, TNF-alpha, and GSTA1-1.
  
  
  RESULTS
  During a HELLP exacerbation CRP, IL-6, IL-1Ra, and GSTA1-1 levels are significantly increased (p < 0.01). In the group of patients treated with prednisolone, significantly lower IL-6 levels were observed during a HELLP exacerbation, compared with patients who did not receive prednisolone (p < 0.01).
  
  
  CONCLUSIONS
  HELLP syndrome is associated with an increased inflammatory response. Circulating IL-6 levels in HELLP syndrome are reduced during prednisolone administration, suggesting a stabilizing effect on the inflammatory endothelial process.
authors.affiliation: Department of Perinatology and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands. heimel@hotmail.com
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: van Runnard Heimel
authors.forename: Annemiek
authors.initials: A
authors.lastname: Kavelaars
authors.forename: Cobie J
authors.initials: CJ
authors.lastname: Heijnen
authors.forename: Wilbert H M
authors.initials: WH
authors.lastname: Peters
authors.forename: Anjoke J M
authors.initials: AJ
authors.lastname: Huisjes
authors.forename: Arie
authors.initials: A
authors.lastname: Franx
authors.forename: Hein W
authors.initials: HW
authors.lastname: Bruinse
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D017359:HELLP Syndrome / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000188:drug therapy*; D011239:Prednisolone / Q000627:therapeutic use*; D011247:Pregnancy
chemical_list: D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D011239:Prednisolone