Hemolysis, elevated liver enzymes, and low platelet syndrome: Outcomes for patients admitted to intensive care at a tertiary referral hospital.
OBJECTIVE
The aim was to assess outcomes for pregnancies in which hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome develops and the patient requires transfer for critical care.


METHODS
The cases of women with HELLP syndrome who delivered at our tertiary center or surrounding hospitals and were admitted to the intensive care between January 2007 and July 2012 were retrospectively analyzed. Results were compared for the surviving and non-surviving patients.


RESULTS
Among the 77 women with HELLP syndrome, maternal mortality rate was 14% and 24 (30%) of 81 fetuses and newborns died in the perinatal period. The most common maternal complications were disseminated intravascular coagulation (DIC) (n = 22; 29%), acute renal failure (n = 19; 25%), and postpartum hemorrhage (n = 16; 21%). Compared with surviving women, the non-surviving women had higher mean international normalized ratio (INR) (p < 0.0001); higher mean serum levels of aspartate aminotransferase (AST) (p < 0.0001); higher alanine aminotransferase (ALT) (p < 0.0001); higher lactate dehydrogenase (LDH) (p < 0.0001), and higher bilirubin (p = 0.040) levels; and lower platelet count (p = 0.005).


CONCLUSIONS
DIC is a major risk factor for maternal outcome among patients with HELLP syndrome who require intensive care. Low platelet count; high AST, ALT, LDH, INR; and total bilirubin are associated with high mortality risk in this patient group. In addition, low platelet count; low fibrinogen level; prolonged activated thromboplastin time; high INR; and high total bilirubin, LDH, blood urea nitrogen, and creatinine are associated with high risk for complications in this patient group.
a Department of Anesthesiology and Reanimation , Baskent University School of Medicine , Ankara , Turkey.
Ender
E
Gedik
b Department of Emergency Medicine , Inonu University School of Medicine , Malatya , Turkey.
Neslihan
N
Yücel
c Department of Anesthesiology and Reanimation , Ersin Arslan State Hospital , Gaziantep , Turkey.
Taylan
T
Sahin
d Department of Anesthesiology and Reanimation , Malatya State Hospital , Malatya , Turkey.
Erdinc
E
Koca
e Department of Anesthesiology and Reanimation , Inonu University School of Medicine , Malatya , Turkey.
Yusuf Ziya
YZ
Colak
e Department of Anesthesiology and Reanimation , Inonu University School of Medicine , Malatya , Turkey.
Turkan
T
Togal
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D001663:Bilirubin / Q000097:blood; D003422:Critical Care; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000401:mortality*; D005260:Female; D017359:HELLP Syndrome / Q000097:blood / Q000401:mortality*; D006461:Hemolysis / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007902:Length of Stay; D008428:Maternal Mortality; D066087:Perinatal Death; D010976:Platelet Count; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers
D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin
Complications; cesarean delivery; disseminated intravascular coagulation; intensive care unit; pregnancy