Comparative Analysis Between Invalidated Biochemical Markers and the Well-established Markers of HELLP Syndrome

Abstract

<i>Background</i>: The use of the well-established markers of the Hemolysis, Elevated Liver enzymes and Low Platelet (HELLP) syndrome is very limited in the resource-poor settings of the developing populations. This study aimed to compare the readily available but invalidated biochemical markers with the well-established markers of HELLP syndrome. <i>Methods</i>: This was a retrospective cross-sectional study conducted among women diagnosed with HELLP syndrome in the University of Port Harcourt Teaching Hospital (UPTH) from 2011 to 2020. Data of each eligible case was acquired from the laboratory and medical records using a well-structured template and analyzed by standardized protocols. <i>Results</i>: A total of 230 cases of HELLP syndrome was identified; 200 complete HELLP (cHELLP) and 30 partial HELLP (pHELLP) variants. The cHELLP variants presented at an older age, higher gestational age, and had higher plasma bilirubin (PB), lactate dehydrogenase (LDH), creatinine, and uric acid (UA) but lower albumin concentration compared to those with pHELLP variant (p<0.05). With worsening severity, there was an increasing trend of plasma creatinine and UA but a decreasing trend of albumin among the cHELLP variants (p<0.05). UA level exhibited the strongest positive correlation with PB, LDH, aspartate, and alanine aminotransferases and maintained the strongest negative correlation with platelet count among those with cHELLP variants (p<0.05). At a cut-off value of 1.5 mmol/L, plasma UA (AUC:0.968; 95%CI:0.913-1.000;p<0.001) level had the most robust ROC values compared to those of plasma creatinine and albumin among the cHELLP variants. <i>Conclusion</i>: From the foregoing, plasma UA should be considered as an adjunct marker of cHELLP syndrome. However, further studies are highly recommended to evaluate conclusions from this study.