Hypofibrinogenemia is a risk factor of poor prognosis of HELLP syndrome

Abstract

Objective Observing changes in thehaemostatic system to determinetheseverity and prognosis of HELLP syndrome. Methods 127 cases of HELLP syndrome diagnosed in Peking University Third Hospital were enrolled from August 2010 to August 2018. Maternal and fetaldemographic characters, postpartum complications,length of hospital stay,prothrombin time(PT),activated partial thromboplastin time (APTT), Fibrinogen(Fg) and D-Dimer(D-D) were collected. Results There was no statistical difference inparturient PT, APTT, D-D levels between maternals of HELLP syndrome with and without postpartum hemorrhage,which were [9.6 (9.0, 11.5)s vs 9.4 (8.9, 9.7)s, P=0.243], [30.2 (29.1, 38.3)s vs 29.8 (27.7, 31.8)s, P=0.151], and [0.80 (0.52, 4.52)μg/ml vs 0.91 (0.55, 2.48)μg/ml, P=0.923] respectively. There was a statistically significant difference obvious difference in parturient Fglevels between two groups [(2.94±1.48) g/L vs (3.61±1.00)g/L, P=0.022). The receiver operating characteristic curve(ROC) analysis showed that the AUC of fibrinogen level when estimating postpartum hemorrhage was 0.688(95%CI: 0.600-0.767), cut-off value was 3.04 g/L, negative predictive value was 74.3%. There was a negative correlation between parturient Fg and days of hospital stay of HELLP syndrome maternal(r=-0.182, P=0.040). There was no statistical difference in parturient PT, APTT, Fg and D-D levels between the fetal survival group(n=93) and non-survival group (n=34), and between the distressed group (n=23) and he undistressed group(n=70) (P>0.05). Conclusions The low parturient Fg level may be a risk factor of maternal adverse clinical outcomes in HELLP syndrome. Maintaining the Fg at a stable level may reduce the incidence of HELLP syndrome adverse outcomes. Key words: HELLP Syndrome; Fibrinogen; Postpartum hemorrhage; Risk factors