The impact of biochemical marker levels in pregnant patients diagnosed with HELLP syndrome on predicting the progression and recovery timelines

Year 2025, Volume: 11 Issue: 5, 868 - 877, 04.09.2025

Mehmet Alican Sapmaz , Sait Erbey , Murat Polat , Ahmet Kurt , Dilara Sarıkaya Kurt , Kadriye Yakut Yücel , Recep Taha Ağaoğlu

https://doi.org/10.18621/eurj.1681181

Abstract

Objectives: This study investigates the role of biochemical markers in predicting the clinical course of pregnant women with Hemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) syndrome, aiming to correlate marker levels with disease progression and recovery timelines for improved prognostic assessment and therapeutic strategies.

Methods: A retrospective analysis was conducted on 50 pregnant patients (aged 18-45) diagnosed with HELLP syndrome between October 2022 and November 2023. Data on demographics, vital signs, clinical symptoms, and laboratory markers (platelets, liver enzymes, lactate dehydrogenase [LDH], and bilirubin) were examined. Outcomes measured included complications, intensive care unit needs, and recovery time.

Results: The mean age was 30.74±5.27 years and body mass index of 29.76±5.88 kg/m2. The gestational age was 31.97±4.45 weeks. Significant cut-off values were identified for urea at 27.50 (sensitivity: 100%, specificity: 73%, R2= 0.553, P<0.001) and creatinine at 0.85 (sensitivity: 100%, specificity: 91%, (P<0.001). LDH, bilirubin, and platelets also showed predictive value for clinical outcomes (P-values ranging from 0.005 to <0.05). Neutrophil-to-Lymphocyte Ratio and urea correlated with longer postpartum stays and complications, while higher mean platelet volume was linked to shorter stays (NLR: β = 0.303, P=0.009; BUN: β = 0.553, P< 0.001).

Conclusions: The study highlights the importance of renal and hematological markers (urea, creatinine, LDH, bilirubin, platelets) in predicting HELLP outcomes. Renal markers showed high sensitivity, while hematological markers correlated with hospital stay duration, supporting their integration into clinical protocols to optimize treatment and patient management.

Keywords

Biomarkers , HELLP syndrome , hospital stay , predictive value

Ethical Statement

This study was approved by the Ankara Etlik City Hospital No. 1 Clinical Research Ethics Committee (Decision No: AEŞH-EK1-2023-728; date: 06.12.2023). All procedures were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Informed consent was waived because of the retrospective nature of the study and the analysis used anonymous clinical data.

References

• 1. Adorno M, Maher-Griffiths C, Grush Abadie HR. HELLP Syndrome. Crit Care Nurs Clin North Am. 2022;34(3):277-288. doi: 10.1016/j.cnc.2022.04.009.
• 2. Lazo-Vega L, Toledo-Jaldin L, Badner A, et al. ACOG and local diagnostic criteria for hypertensive disorders of pregnancy (HDP) in La Paz-El Alto, Bolivia: A retrospective case-control study. Lancet Reg Health Am. 2022;9:100194. doi: 10.1016/j.lana.2022.100194.
• 3. Ives CW, Sinkey R, Rajapreyar I, Tita ATN, Oparil S. Preeclampsia-Pathophysiology and Clinical Presentations: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;76(14):1690-1702. doi: 10.1016/j.jacc.2020.08.014.
• 4. Turbeville HR, Sasser JM. Preeclampsia beyond pregnancy: long-term consequences for mother and child. Am J Physiol Renal Physiol. 2020;318(6):F1315-F1326. doi: 10.1152/ajprenal.00071.2020.
• 5. Ditisheim A, Sibai BM. Diagnosis and Management of HELLP Syndrome Complicated by Liver Hematoma. Clin Obstet Gynecol. 2017;60(1):190-197. doi: 10.1097/GRF.0000000000000253.
• 6. Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy Childbirth. 2009;9:8. doi: 10.1186/1471-2393-9-8.
• 7. James JL, Whitley GS, Cartwright JE. Pre-eclampsia: fitting together the placental, immune and cardiovascular pieces. J Pathol. 2010;221(4):363-378. doi: 10.1002/path.2719.
• 8. Habli M, Eftekhari N, Wiebracht E, Bombrys A, Khabbaz M, How H, Sibai B. Long-term maternal and subsequent pregnancy outcomes 5 years after hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Am J Obstet Gynecol. 2009;201(4):385.e1-5. doi: 10.1016/j.ajog.2009.06.033.
• 9. Lisonkova S, Razaz N, Sabr Y, et al. Maternal risk factors and adverse birth outcomes associated with HELLP syndrome: a population-based study. BJOG. 2020;127(10):1189-1198. doi: 10.1111/1471-0528.16225.
• 10. Sibai BM. Diagnosis, controls, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004;103(5 Pt 1):981-991. doi: 10.1097/01.AOG.0000126245.35811.2a.
• 11. Abildgaard U, Heimdal K. Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): a review. Eur J Obstet Gynecol Reprod Biol. 2013;166(2):117-123. doi: 10.1016/j.ejogrb.2012.09.026.
• 12. Young BC, Levine RJ, Karumanchi SA. Pathogenesis of preeclampsia. Annu Rev Pathol. 2010;5:173-192. doi: 10.1146/annurev-pathol-121808-102149.
• 13. Landi B, Tranquilli AL. HELLP syndrome and placental inflammatory pathology. Minerva Ginecol. 2008;60(5):389-398.
• 14. İpek G, Tanaçan A, Ağaoğlu Z, Peker A, Şahin D. Can SIRI or other inflammatory indices predict HELLP syndrome in the first trimester? J Reprod Immunol. 2023;159:104126. doi: 10.1016/j.jri.2023.104126.
• 15. Sisti G, Faraci A, Silva J, Upadhyay R. Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Routine Complete Blood Count Components in HELLP Syndrome: A Matched Case Control Study. Medicina (Kaunas). 2019;55(5):123. doi: 10.3390/medicina55050123.