- Poster presentation
Hemolysis Elevated Liver Low Platelet Acute Renal Dysfunction syndrome: evidence for a new entity in the critically ill obstetric patient
Critical Care volume 10, Article number: P274 (2006)
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  and containing renal dysfunction as a prognostic factor.
Patients and methods
A retrospective analysis of the prospectively collected data part of the APRiMo study . 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.
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.
Magann E, Martin J: Clin Obstetrics Gynecol. 1999, 42: 532. 10.1097/00003081-199909000-00009
Haddad , et al.: Crit Care. 2005, 9: S92-S93.
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Haddad, Z., Kaddour, C. & Skandrani, L. Hemolysis Elevated Liver Low Platelet Acute Renal Dysfunction syndrome: evidence for a new entity in the critically ill obstetric patient. Crit Care 10, P274 (2006). https://doi.org/10.1186/cc4621
- Acute Renal Failure
- Sofa Score
- HELLP Syndrome
- Acute Renal Dysfunction
- Syndrome Classification