Can First-trimester AST to Platelet Ratio Index Scores Predict HELLP Syndrome?

Abstract

To determine whether the ratio of the first-trimester aspartate aminotransferase (AST) to platelet ratio index (APRI) score will be useful as a new determinant of hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome that may develop in the later stages of pregnancy Study Design: Descriptive-analytical study. Perinatology Clinic of Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey. The data of patients diagnosed as having HELLP syndrome between 2018 and 2020 were analyzed retrospectively. Forty-two pregnant women with HELLP syndrome as the study group and 74 pregnant women with no morbidities as the control group were included in the study. First-trimester APRI scores were compared for both the groups. A characteristic curve (ROC) analysis of the study was performed to determine the APRI score levels predicting HELLP syndrome. One hundred and sixteen women with HELLP syndrome had significantly lower fibrinogen levels and platelet (PLT) levels than women without HELLP syndrome (p<0.001). Women with HELLP syndrome had significantly higher ALT, AST, creatinine, and INR levels. These differences were significantly different (p<0.001). Women who developed HELLP syndrome in the third trimester of pregnancy had significantly higher first-trimester APRI scores (0.64±0.10) than the control group (0.40±0.12, p<0.001). In the ROC analysis, 0.55 as a cut-off value for first-trimester APRI scores had a sensitivity of 88.1 % and a specificity of 94.6 % for predicting HELLP syndrome developing in the third trimester of pregnancy. There was an association of first-trimester APRI scores with the prediction of HELLP syndrome, possibly developing in the later weeks of pregnancy. Predicting HELLP syndrome in the early period can assist in proper management and taking necessary precautions. Key Words: HELLP syndrome prediction, First-trimester APRI, APRI scores in pregnancy, APRI score.