title: Postpartum acute renal failure: a multicenter study of risk factors in patients admitted to ICU.
abstract: BACKGROUND
  Even in developed countries, severe specific pregnancy complications may occur in the immediate postpartum period and require admission to the ICU. The characteristics and risk factors of acute renal failure (ARF) induced by these complications and their treatments are not well known.
  
  
  METHODS
  We performed a retrospective multicenter study in three intensive care departments linked to level III maternity wards in the north of France. All patients admitted to ICU for postpartum complications over a 5-year period (2008 to 2012) were included. Clinical and biological data, delivery characteristics, type of complications, and treatments were compared by univariate and multivariate analyses according to the occurrence and severity of ARF.
  
  
  RESULTS
  One hundred eighty-two patients admitted to ICU for postpartum complications were included in the study. Sixty-eight patients (37%) developed an ARF: 49 with a low or medium severity and 19 with a severe ARF requiring renal replacement therapy. Hemolysis, elevated liver enzyme, and low platelet count (HELLP) syndrome on its own (p = 0.047) or combined with postpartum haemorrhage (p = 0.003), previous treatment by hyperoncotic albumin infusion (p = 0.001) and blockade of fibrinolysis by tranexamic acid (p = 0.03), was associated with secondary ARF. By multivariate analysis, the only independent factors were the association of HELLP syndrome with postpartum haemorrhage and the use of hyperoncotic albumin infusion.
  
  
  CONCLUSIONS
  HELLP syndrome associated with postpartum haemorrhage induces a high risk of ARF in the complicated postpartum setting. A particular attention should be given to treatments that could worsen the kidney function in that situation.
authors.affiliation: Servie de Réanimation Polyvalente, Centre de Réanimation, Hôpital Roger Salengro, CHRU, 2 Avenue Oscar Lambret, Lille Cedex 59037, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Jonard
authors.affiliation: Service d'Anesthésie Obstétricale, Hôpital Jeanne de Flandre, CHRU, 2 Avenue Oscar Lambret, Lille Cedex 59037, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Ducloy-Bouthors
authors.affiliation: Royal Cancer Hospital, The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK.
authors.forename: Eileen
authors.initials: E
authors.lastname: Boyle
authors.affiliation: Service de Réanimation Polyvalente, Centre Hospitalier du Docteur Schaffner, 99, route de la Bassée, Lens 62300, France.
authors.forename: Maryse
authors.initials: M
authors.lastname: Aucourt
authors.affiliation: Service de Réanimation Polyvalente, Centre Hospitalier du Docteur Schaffner, 99, route de la Bassée, Lens 62300, France.
authors.forename: Gaelle
authors.initials: G
authors.lastname: Gasan
authors.affiliation: Servie de Réanimation Polyvalente, Centre de Réanimation, Hôpital Roger Salengro, CHRU, 2 Avenue Oscar Lambret, Lille Cedex 59037, France.
authors.forename: Merce
authors.initials: M
authors.lastname: Jourdain
authors.affiliation: Service de Réanimation polyvalente, Centre Hospitalier de Valenciennes, Avenue Désandrouin, Valenciennes 59300, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Mignaux
authors.affiliation: Service de Maternité Monaco, Centre Hospitalier de Valenciennes, Avenue Désandrouin, Valenciennes 59300, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Tillouche
authors.affiliation: Servie de Réanimation Polyvalente, Centre de Réanimation, Hôpital Roger Salengro, CHRU, 2 Avenue Oscar Lambret, Lille Cedex 59037, France.
authors.forename: François
authors.initials: F
authors.lastname: Fourrier
keywords: Acute renal failure; HELLP syndrome; Hyperoncotic albumin; Intensive care; Postpartum complications; Postpartum haemorrhage; Pregnancy; Tranexamic acid