Hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome versus severe preeclampsia: a critical care comparative study

Objective

We performed this study to assess the clinical spectrum and evaluate the outcome of patients with HELLP syndrome compared with those with severe pre-eclampsia but without HELLP managed in the intensive care unit (ICU). Serum albumin level was measured as a prognostic factor.

Study design

A prospective clinical and laboratory study that was conducted over an 18-month period where 67 pre-eclamptic postpartum women admitted to the ICU were studied, and were divided into two groups. Group I (21 patients with HELLP syndrome) and group II (46 patients with severe pre-eclampsia only) were compared and contrasted concerning medical and laboratory data.

Results

Patients in group I were older than those of group II (28.7 ± 6.6 vs 24.5 ± 4.6, P < 0.05) and had higher medical complications than patients in group II. Eclampsia 62% vs 19% (odds ratio = 5.95% confidence interval [CI] = 1.2–20.6, P < 0.01), adult respiratory distress syndrome with respiratory failure 29% vs 4% (odds ratio = 12.4, 95% CI = 1.2–12.6, P < 0.01), multiorgan failure (MOF) 43% vs 4% (odds ratio = 8.4, 95% CI = 1.4–52, P < 0.005) and mortality 38% vs 7% (odds ratio = 11.6, 95%, CI = 1.9–70.2, P < 0.01). There was no significant difference between both groups concerning disseminated intravascular coagulation and circulatory failure. Serum albumin on admission was significantly lower in HELLP syndrome patients (2.2 ± 0.6 g/dl) than patients with severe pre-eclampsia (2.8 ± 0.6 g/dl, P = 0.01). Serum albumin correlated significantly with both MOF (t value = 2.7, DF = 40, P = 0.01) and mortality (t value = 3.7, DF = 27, P = 0.001).

Conclusion

Pre-ecalmptic patients with HELLP syndrome are amenable for serious medical complications and higher mortality rate than patients with severe pre-eclampsia but no HELLP syndrome. Serum albumin is lower in patients with HELLP syndrome and correlates well with the development of MOF and mortality so it can be used as a useful predictor of both morbidity and mortality in critically ill pre-ecalmptic patients.