S1189 Efficacy of Corticosteroid Administration in Patients With Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) Syndrome: A Meta-Analysis

Abstract

Introduction: Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is considered an obstetrical emergency, posing risk for high maternal morbidity and mortality if left untreated. While corticosteroids (CS) have been postulated to modify some of the pro-inflammatory features of HELLP syndrome, results from meta-analyses have thus far lacked the evidence to support CS’ overall benefit in attenuating disease process. In the past several years, there has been additional data published on the use of CS in HELLP syndrome, prompting an updated meta-analysis on the matter. Our study aims to evaluate the prognostic benefits of CS in HELLP syndrome. Methods: We performed a systematic literature review using multiple electronic databases. Continuous data under the generic inverse variance model was pooled and expressed as a standardized mean difference while the dichotomous data was analyzed using the Mantel-Haenszel model and expressed as odds ratios. Results: Nineteen studies were included. Administration of CS in HELLP syndrome was associated with a significantly increased platelet count (MD: 38.71 p < 0.05), decreased LDH (MD: -0.17 p < 0.05), decreased requirement for packed red blood cell transfusion (OR: 0.46 p < 0.05), decreased requirement for plasma transfusion (OR: 0.29 p < 0.05), and an increased risk of infection (OR: 1.65 p < 0.05). There was no significant difference in the following outcomes: hemorrhage, cardiopulmonary edema, renal failure, transaminitis, mode of delivery, eclampsia, and maternal death. Conclusion: Our results reaffirm those of prior meta-analyses conducted on the effects of CS in HELLP syndrome. Particularly, they highlight CS known effect in optimizing platelet count for the obstetrical patient. Interestingly, our meta-analysis demonstrates a significant decrease in LDH amongs patients with HELLP who received CS. As LDH is a known byproduct of hepatic dysfunction, our findings suggest a possible hepato-protective role of CS on the cellular level. While the effect of CS on hepatic morbidity was not statistically significant, the small sample size of women diagnosed with serious liver pathology made it challenging to assess the clinical impact thereof. At this time, there is not enough evidence to recommend utilization of CS for a hepatic benefit, given their deleterious effect on rates of maternal infection. Future studies with larger sample size data of liver injury in HELLP are warranted to evaluate the impact of CS on hepatic morbidity.Figure 1.: This forrest plot reflects that platelet count increases with corticosteroid administration in patients with HELLP syndrome.