Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

01-12-2020 | Acute Kidney Injury | Research article

Effect of HELLP syndrome on acute kidney injury in pregnancy and pregnancy outcomes: a systematic review and meta-analysis

Authors: Qiang Liu, Guan-jun Ling, Shao-quan Zhang, Wen-qing Zhai, Yi-juan Chen

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Login to get access

Abstract

Background

HELLP syndrome may increase adverse pregnancy outcomes, though the incidence of it is not high. At present, the impact of HELLP syndrome on P-AKI (acute kidney injury during pregnancy) and maternal and infant outcomes is controversial. Thus, we conducted a meta-analysis to find out more about the relationship between HELLP syndrome and P-AKI and pregnancy outcomes.

Methods

We systematically searched PubMed, Embassy and Cochrane Databases for cohort studies and RCT to assess the effect of HELLP syndrome on P-AKI and maternal and infant outcomes. Study-specific risk estimates were combined by using fixed-effect or random-effect models.

Results

This meta-analysis included 11 cohort studies with a total of 6333 Participants, including 355 cases of pregnant women with HELLP syndrome and 5979 cases that without. HELLP syndrome was associated with relatively higher risk of P-AKI (OR4.87 95% CI 3.31 ~ 7.17, P<0.001), fetal mortality (OR1.56 95% CI 1.45 ~ 2.11, P<0.001) and Maternal death (OR3.70 95% CI 1.72 ~ 7.99, P<0.001).

Conclusions

HELLP syndrome is associated with relatively higher risk of P-AKI, fetal mortality and maternal death.
Literature
1.
Gedik E, Yucel N, Sahin T, Koca E, Colak YZ, Togal T. 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):21–9.CrossRefPubMed
2.
Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol. 1982;142(2):159–67.CrossRefPubMed
3.
Celik C, Gezginc K, Altintepe L, Tonbul HZ, Yaman ST, Akyurek C, Turk S. Results of the pregnancies with HELLP syndrome. Ren Fail. 2003;25(4):613–8.CrossRefPubMed
4.
Gul A, Cebeci A, Aslan H, Polat I, Ozdemir A, Ceylan Y. Perinatal outcomes in severe preeclampsia-eclampsia with and without HELLP syndrome. Gynecol Obstet Investig. 2005;59(2):113–8.CrossRef
5.
Haddad B, Barton JR, Livingston JC, Chahine R, Sibai BM. Risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Am J Obstet Gynecol. 2000;183(2):444–8.CrossRefPubMed
6.
Cavkaytar S, Ugurlu EN, Karaer A, Tapisiz OL, Danisman N. Are clinical symptoms more predictive than laboratory parameters for adverse maternal outcome in HELLP syndrome? Acta Obstet Gynecol Scand. 2007;86(6):648–51.CrossRefPubMed
7.
Gul A, Aslan H, Cebeci A, Polat I, Ulusoy S, Ceylan Y. Maternal and fetal outcomes in HELLP syndrome complicated with acute renal failure. Ren Fail. 2004;26(5):557–62.CrossRefPubMed
8.
Haddad B, Barton JR, Livingston JC, Chahine R, Sibai BM. HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome versus severe preeclampsia: onset at < or =28.0 weeks' gestation. Am J Obstet Gynecol. 2000;183(6):1475–9.CrossRefPubMed
9.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100.CrossRefPubMedPubMedCentral
10.
Wells G, Shea B, O'connell D, Peterson J, Welch V, Losos M and Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa (ON): Ottawa Hospital Research Institute; 2009.
11.
12.
13.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994:1088–101.
14.
Zuberi NF, Arif K, Khan FM, Pal JA. A comparison of severe pre-eclampsia/eclampsia in patients with and without HELLP syndrome. J Pakistan Med Assoc. 1998;48(2):29–32.
15.
Yıldırım G, Güngördük K, Aslan H, Gül A, Bayraktar M, Ceylan Y. Comparison of perinatal and maternal outcomes of severe preeclampsia, eclampsia, and HELLP syndrome. J Turkish German Gynecol Assoc. 2011;12(2):90.CrossRef
16.
Abroug F, Boujdaria R, Nouira S, Abroug S, Souissi M, Najjar M, Secourgeon J, Bouchoucha S. HELLP syndrome: incidence and maternal-fetal outcome—a prospective study. Intensive Care Med. 1992;18(5):274–7.CrossRefPubMed
17.
Liu CM, Chang SD, Cheng PJ, Chao AS. Comparisons of maternal and perinatal outcomes in Taiwanese women with complete and partial HELLP syndrome and women with severe pre-eclampsia without HELLP. J Obstet Gynaecol Res. 2006;32(6):550–8.CrossRefPubMed
18.
Martin JN Jr, Perry KG Jr, Miles JF Jr, Blake PG, Magann EF, Roberts WE, Martin RW. The interrelationship of eclampsia, HELLP syndrome, and prematurity: cofactors for significant maternal and perinatal risk. BJOG Int J Obstet Gynaecol. 1993;100(12):1095–100.CrossRef
19.
Turgut A, Demirci O, Demirci E, Uludoğan M. Comparison of maternal and neonatal outcomes in women with HELLP syndrome and women with severe preeclampsia without HELLP syndrome. J Prenatal Med. 2010;4(3):51.
20.
Abramovici D, Friedman SA, Mercer BM, Audibert F, Kao L, Sibai BM. Neonatal outcome in severe preeclampsia at 24 to 36 weeks' gestation: does the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome matter? Am J Obstet Gynecol. 1999;180(1):221–5.CrossRefPubMed
21.
Osmanağaoğlu MA, Erdoğan İ, Zengin Ü, Bozkaya H. Comparison between HELLP syndrome, chronic hypertension, and superimposed preeclampsia on chronic hypertension without HELLP syndrome. J Perinat Med. 2004;32(6):481–5.CrossRefPubMed
22.
Drakeley AJ, Le Roux PA, Anthony J, Penny J. Acute renal failure complicating severe preeclampsia requiring admission to an obstetric intensive care unit. Am J Obstet Gynecol. 2002;186(2):253–6.CrossRefPubMed
23.
Aydin S, Ersan F, Ark C, Arıoğlu Aydın Ç. Partial HELLP syndrome: maternal, perinatal, subsequent pregnancy and long-term maternal outcomes. J Obstet Gynaecol Res. 2014;40(4):932–40.CrossRefPubMed
24.
Sibai BM, Ramadan MK. Acute renal failure in pregnancies complicated by hemolysis, elevated liver enzymes, and low platelets. Am J Obstet Gynecol. 1993;168(6):1682–90.CrossRefPubMed
25.
Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004;103(5):981–91.CrossRefPubMed
26.
27.
Yildirim G, Gungorduk K, Gul A, Asicioglu O, Sudolmus S, Gungorduk OC, Ceylan Y. HELLP syndrome: 8 years of experience from a tertiary referral center in western Turkey. Hypertens Pregnancy. 2012;31(3):316–26.CrossRefPubMed
28.
Joshi D, James A, Quaglia A, Westbrook RH, Heneghan MA. Liver disease in pregnancy. Lancet. 2010;375(9714):594–605.CrossRefPubMed
29.
Kuklina EV, Ayala C, Callaghan WM. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet Gynecol. 2009;113(6):1299–306.CrossRefPubMed
30.
Fakhouri F, Jablonski M, Lepercq J, Blouin J, Benachi A, Hourmant M, Pirson Y, Dürrbach A, Grünfeld J-P, Knebelmann B. Factor H, membrane cofactor protein, and factor I mutations in patients with hemolysis, elevated liver enzymes, and low platelet count syndrome. Blood. 2008;112(12):4542–5.CrossRefPubMed
31.
Sibai BM, Taslimi MM, el-Nazer A, Amon E, Mabie BC, Ryan GM: Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia. Am J Obstet Gynecol 1986, 155(3):501–509.
32.
Ghosh AK, Vashisht K, Varma S, Khullar D, Sakhuja V. Acute renal failure in a patient with HELLP syndrome--an unusual complication of eclampsia. Ren Fail. 1994;16(2):295–8.CrossRefPubMed
33.
Abraham KA, Kennelly M, Dorman AM, Walshe JJ. Pathogenesis of acute renal failure associated with the HELLP syndrome: a case report and review of the literature. Eur J Obstet Gynecol Reprod Biol. 2003;108(1):99–102.CrossRefPubMed
34.
Fang JT, Chen YC, Huang CC. Unusual presentation of mesangial proliferative glomerulonephritis in HELLP syndrome associated with acute renal failure. Ren Fail. 2000;22(5):641–6.CrossRefPubMed
35.
Gupta A, Ferguson J, Rahman M, Weber-Shrikant E, Venuto R. Acute oliguric renal failure in HELLP syndrome: case report and review of literature. Ren Fail. 2012;34(5):653–6.CrossRefPubMed
36.
Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing. Am J Obstet Gynecol. 1990;162(2):311–6.CrossRefPubMed
37.
Liu Y, Ma X, Zheng J, Liu X, Yan T. Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2017;17(1):235.CrossRefPubMedPubMedCentral
Metadata
Title
Effect of HELLP syndrome on acute kidney injury in pregnancy and pregnancy outcomes: a systematic review and meta-analysis
Authors
Qiang Liu
Guan-jun Ling
Shao-quan Zhang
Wen-qing Zhai
Yi-juan Chen
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-03346-4

Other articles of this Issue 1/2020

BMC Pregnancy and Childbirth 1/2020 Go to the issue

Research article

Postnatal care education in health facilities in Accra, Ghana: perspectives of mothers and providers

Research article

Trends in smoking during pregnancy by socioeconomic characteristics in the United States, 2010–2017

Research article

Gestational weight gain counselling practices among different antenatal health care providers: a qualitative grounded theory study

Research article

Women’s experience of psychological birth trauma in China: a qualitative study

Research article

Maternal plasma lipid levels across pregnancy and the risks of small-for-gestational age and low birth weight: a cohort study from rural Gambia

Research article

Eliciting women’s preference for prenatal testing in China: a discrete choice experiment