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Hemolysis, elevated liver enzymes, and low platelet syndrome: Outcomes for patients admitted to intensive care at a tertiary referral hospital.
Hypertens Pregnancy. 2017 Feb; 36(1):21-29.HP

Abstract

PURPOSE

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.

MATERIALS AND 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).

CONCLUSION

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.

Authors+Show Affiliations

a Department of Anesthesiology and Reanimation , Baskent University School of Medicine , Ankara , Turkey.b Department of Emergency Medicine , Inonu University School of Medicine , Malatya , Turkey.c Department of Anesthesiology and Reanimation , Ersin Arslan State Hospital , Gaziantep , Turkey.d Department of Anesthesiology and Reanimation , Malatya State Hospital , Malatya , Turkey.e Department of Anesthesiology and Reanimation , Inonu University School of Medicine , Malatya , Turkey.e Department of Anesthesiology and Reanimation , Inonu University School of Medicine , Malatya , Turkey.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27599183

Citation

Gedik, Ender, et al. "Hemolysis, Elevated Liver Enzymes, and Low Platelet Syndrome: Outcomes for Patients Admitted to Intensive Care at a Tertiary Referral Hospital." Hypertension in Pregnancy, vol. 36, no. 1, 2017, pp. 21-29.
Gedik E, Yücel N, Sahin T, et al. Hemolysis, elevated liver enzymes, and low platelet syndrome: Outcomes for patients admitted to intensive care at a tertiary referral hospital. Hypertens Pregnancy. 2017;36(1):21-29.
Gedik, E., Yücel, N., Sahin, T., Koca, E., Colak, Y. Z., & Togal, T. (2017). Hemolysis, elevated liver enzymes, and low platelet syndrome: Outcomes for patients admitted to intensive care at a tertiary referral hospital. Hypertension in Pregnancy, 36(1), 21-29. https://doi.org/10.1080/10641955.2016.1218505
Gedik E, et al. Hemolysis, Elevated Liver Enzymes, and Low Platelet Syndrome: Outcomes for Patients Admitted to Intensive Care at a Tertiary Referral Hospital. Hypertens Pregnancy. 2017;36(1):21-29. PubMed PMID: 27599183.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemolysis, elevated liver enzymes, and low platelet syndrome: Outcomes for patients admitted to intensive care at a tertiary referral hospital. AU - Gedik,Ender, AU - Yücel,Neslihan, AU - Sahin,Taylan, AU - Koca,Erdinc, AU - Colak,Yusuf Ziya, AU - Togal,Turkan, Y1 - 2016/09/06/ PY - 2016/9/7/pubmed PY - 2017/9/2/medline PY - 2016/9/7/entrez KW - Complications KW - cesarean delivery KW - disseminated intravascular coagulation KW - intensive care unit KW - pregnancy SP - 21 EP - 29 JF - Hypertension in pregnancy JO - Hypertens Pregnancy VL - 36 IS - 1 N2 - PURPOSE: 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. MATERIALS AND 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). CONCLUSION: 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. SN - 1525-6065 UR - https://www.unboundmedicine.com/medline/citation/27599183/Hemolysis_elevated_liver_enzymes_and_low_platelet_syndrome:_Outcomes_for_patients_admitted_to_intensive_care_at_a_tertiary_referral_hospital_ L2 - https://www.tandfonline.com/doi/full/10.1080/10641955.2016.1218505 DB - PRIME DP - Unbound Medicine ER -