title: PP039. The importance of intentionally considering class 1 HELLP syndrome outcomes versus all other categories of HELLP syndrome or severe preeclampsia.
abstract: BACKGROUND
  Combining HELLP syndrome patient groups in publications and presentations may obfuscate any potential differences among patient groups with regard to maternal-perinatal outcomes and rendered therapies.
  
  
  OBJECTIVE
  We explored the prevalence of major maternal morbidity (MMM) for patients with severe preeclampsia (SPRE) and each defined group of HELLP syndrome.
  
  
  METHODS
  Retrospective cohort study 2000-2007 of patients categorized either as class 1 HELLP syndrome (HELLP1, platelets⩽50,000, AST⩽70,LDH⩽600), class 2 (HELLP2, platelets>50,000 to ⩽100,000), class 3 (HELLP3, platelets>100,000 to ⩽150,000), or partial/incomplete (HELLP4) with only 2 of 3 diagnostic parameters present. All SPRE patients (no HELLP) of 2005-2007 were also evaluated. Total MMM for each group was determined. MMM included cardiopulmonary [cardiogenic or noncardiogenic pulmonary edema, pleural or pericardial effusion, pulmonary embolus, indicated intubation, myocardial infarction or arrest], hematologic/coagulation [DIC, transfused blood products], central nervous system/visual [stroke, cerebral edema, hypertensive encephalopathy, vision loss], hepatic [subcapsular hematoma or rupture] or renal complications [acute tubular necrosis or renal failure]. All HELLP1 and HELLP2 patients received corticosteroids, magnesium sulfate and anti-hypertensives. Comparison among groups was done using Chi-square or Fisher exact test at 95% CI.
  
  
  RESULTS
  Four hundred and twenty patients had a form of HELLP syndrome 2000-2007; 688 patients had SPRE 2005-2007.The prevalence of MMM for each patient group was determined: HELLP1=41.5%; HELLP2=10.3%; HELLP3=20.0%; HELLP4=21.0%; and SPRE=17.7%. MMM in HELLP1 was significantly increased over all other groups (P<0.001). Combining MMM for HELLP1+HELLP2 produced a prevalence of 22.1% MMM, insignificantly different from all others including HELLP3, HELLP4 and SPRE (p=0.19), thereby obscuring the significantly elevated MMM of HELLP1 patients.
  
  
  CONCLUSIONS
  Only patients with HELLP1 have significantly increased MMM compared to other HELLP groups or SPRE. Failing to separately evaluate patients with HELLP1 in studies of HELLP syndrome could lead to mistaken conclusions about the effectiveness of a treatment to reduce MMM. All publications reviewing HELLP syndrome management should address how well it functions to reduce patient development of HELLP1 and thus minimize MMM.
authors.affiliation: University of Mississippi Medical Center, Jackson, United States.
authors.forename: J N
authors.initials: JN
authors.lastname: Martin
authors.affiliation: University of Mississippi Medical Center, Jackson, United States.
authors.forename: J M
authors.initials: JM
authors.lastname: Brewer
authors.affiliation: University of Mississippi Medical Center, Jackson, United States.
authors.forename: P G
authors.initials: PG
authors.lastname: Blake
authors.affiliation: University of Mississippi Medical Center, Jackson, United States.
authors.forename: M Y
authors.initials: MY
authors.lastname: Owens
authors.affiliation: University of Mississippi Medical Center, Jackson, United States.
authors.forename: B
authors.initials: B
authors.lastname: LaMarca
authors.affiliation: University of Mississippi Medical Center, Jackson, United States.
authors.forename: I
authors.initials: I
authors.lastname: Sunesara