The Fibrinogen / CRP Ratio as a New Parameter for the Prediction of Disseminated Intravascular Coagulation in Patients with HELLP Syndrome

Abstract

Background: The syndrome of Hemolysis, elevated Liver enzymes, and Low Platelet count (HELLP) is a life-threatening variant of preeclampsia, and may be accompanied by disseminated intravascular coagulation (DIC). Recently the fibrinogen/C-reactive protein (CRP) ratio has been suggested as a measurement that predicts onset of DIC. The authors sought to analyze the fibrinogen/CRP ratio among obstetric patients who developed DIC due to HELLP syndrome. Aim: the aim of this study is to determine if the fibrinogen/C-reactive protein (CRP) ratio could be used as a predictor for disseminated intravascular coagulation in obstetrics patients with the HELLP syndrome. Patients and Methods: this study was conducted as a prospective observational study at Ain Shams Maternity Hospital from November 2014 to November 2016 .The study included Patients diagnosed to have Severe Pre Eclamptic Toxemia SPET according to ACOG (2013).Patients was diagnosed with the HELLP syndrome according to the Martin classification of HELLP syndrome. Results: the results of our study suggest that replacing the use of fibrinogen levels alone with the fibrinogen/CRP ratio would enhance the diagnostic and prognostic power for DIC in patients with HELLP syndrome. Conclusion: in light of the physiologic changes of the coagulation cascade during gestation, the International Society on Thrombosis and Hemostasis ISTH score could not be implemented in pregnant women alone for the diagnosis and prediction of DIC. Recommendations: further evaluation of the fibrinogen/ CRP ratio is required to determine the generalizability of this marker’s use in DIC because of causes such as placental abruption, septic abortion, and failed abortion. Furthermore, prospective studies should be performed to determine the best method to predict if there any new method to predict DIC in patients with the HEELP syndrome.