HELLP syndrome is associated with an increased inflammatory response, which may be inhibited by administration of prednisolone.
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.
van Runnard Heimel
Pieter J
PJ
Department of Perinatology and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands. heimel@hotmail.com
Kavelaars
Annemiek
A
Heijnen
Cobie J
CJ
Peters
Wilbert H M
WH
Huisjes
Anjoke J M
AJ
Franx
Arie
A
Bruinse
Hein W
HW
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
D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D011239:Prednisolone