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  • Open Access

Hemolysis Elevated Liver Low Platelet Acute Renal Dysfunction syndrome: evidence for a new entity in the critically ill obstetric patient

  • 1,
  • 2 and
  • 2
Critical Care200610 (Suppl 1) :P274

  • Published:


  • Acute Renal Failure
  • Sofa Score
  • HELLP Syndrome
  • Acute Renal Dysfunction
  • Syndrome Classification


The incidence of HELLP syndrome complicated with acute renal failure (ARF) is unknown because of a paucity of large series dealing with this subject. Recent experimental and clinical investigations indicate that ARF presents a condition that exerts a fundamental impact on the course of disease, the evolution of associated complications and on prognosis independently from the type and severity of the underlying disease.


To test the pertinence of a new classification of HELLP syndrome derived from the Tennessee Classification [1] and containing renal dysfunction as a prognostic factor.

Patients and methods

A retrospective analysis of the prospectively collected data part of the APRiMo study [2]. Critically ill obstetric patients first managed in tertiary referral maternity care for high-risk pregnancies, then transferred to our independent multidisciplinary ICU. Inclusion criteria: patients that developed HELLP syndrome in prepartum or postpartum. The main outcome of interest was vital status at ICU discharge. Demographic data, obstetric management modalities, diagnosis of ICU admission, SAPS-Obst, APACHE III-J, daily MODS and SOFA scores, and ICU complications were collected. We used the following classification. Complete HELLP syndrome (Class 1): platelets < 100,000/mm3, LDH ≥ 600 UI/l, ASAT ≥ 70 IU/l. Incomplete HELLP syndrome (Class 2): only one or two factors of the aforementioned criteria. B: acute renal dysfunction, with a maximum serum creatinine level between 100 and 200 μmol/l at day 1 of ICU admission. C: ARF, with a maximum serum creatinine level ≥ 200 μmol/l at day 1 of ICU admission. A: no renal dysfunction. Patients presenting with HELLP syndrome could therefore be classified into six different categories.


During the study period January 1996-December 2004, 261 patients developed HELLP syndrome (21.1% mortality) from a database of 640 patients (13.3% overall mortality) (Table 1). In a logistic regression model with renal function represented by three dichotomous variables and HELLP syndrome expressed in a dichotomous manner as follows (Class 1 = 2, Class 2 = 1), B and C are associated with a respective OR concerning mortality of 2.8 and 8.7.
Table 1

(abstract P274)





D/Cl1 (n = 30/80)

n = 1/26*,

n = 7/17

n = 22/37§

D/Cl2 (n = 25/181

n = 9/105*,

n = 5/44

n = 11/32

D/Cl1, dead patients among the Class 1 HELLP syndrome patients/total number of patients with Class1 HELLP syndrome; D/Cl2, dead patients among the Class 2 HELLP syndrome patients/total number of the patients with Class 2 HELLP syndrome. *P < 0.001 A vs C; P < 0.001 A vs B; P = 0.009 vs 2B; §P = 0.039 vs 2C.

Discussion and conclusion

Adding renal dysfunction to the HELLP syndrome classification refined the prognosis of patients. Acute renal dysfunction is a strong independent denominator of survival in the critically ill obstetric patient.

Authors’ Affiliations

Groupe Hospitalier Pitié Salpêtrière, Paris, France
Tunis, Tunis, France


  1. Magann E, Martin J: Clin Obstetrics Gynecol. 1999, 42: 532. 10.1097/00003081-199909000-00009View ArticleGoogle Scholar
  2. Haddad , et al.: Crit Care. 2005, 9: S92-S93.Google Scholar


© BioMed Central Ltd 2006