Critically ill obstetric patients with partial HELLP syndrome: still need HELP?

Introduction

HELLP syndrome is a specific complication of pregnancy characterized by hemolysis, elevated liver enzymes and low platelet count. Frequently, the pregnant patient presents with part of the biological disturbances that define HELLP syndrome, which is commonly known as partial HELLP. Few studies have focused on the specific prognosis of this condition.

Objective

To compare morbidity and mortality related to partial and complete HELLP syndrome [1].

Patients and methods

Retrospective analysis of data collected prospectively from an observational study (APRiMo study [2]). Patients included were critically ill obstetric patients admitted to an independent general ICU and that developed some or all of the biological disturbances characteristic of HELLP syndrome. Study period: January 1996-September 2004. The analysed data involved: acute physiology score at day 1 of hospitalization in the ICU, organ dysfunction, obstetric history and management (transfusion, delivery mode, etc.), and major morbid events in the ICU. The main outcome of interest was survival status at ICU discharge. Patients were divided into three groups: partial HELLP (P), complete HELLP (C) and patients without any criteria of HELLP syndrome (NoH). Significance between groups was assessed by two-tailed Pearson correlation, with P < 0.05 considered significant. Results are expressed as means ± SD. Data were computed using R version 2.1.

Results

See Table 1.

Table 1

Discussion and conclusion

Complete HELLP showed a significantly worse outcome than partial HELLP. But partial HELLP was associated with a high rate of maternal mortality (15%) and a significant increase in major morbid events during ICU hospitalization. It is relevant to distinguish between partial and complete HELLP syndrome (15% vs 40% mortality). Mortality in the case of partial HELLP is still very elevated, sustaining aggressive management as for complete HELLP.