Corticosteroid Therapy for Management of Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) Syndrome: A Meta-Analysis
Minhong Mao, Chen Chen
West Zone, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
Med Sci Monit 2015; 21:3777-3783
Available online: 2015-12-03
Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is a severe condition of pregnancy that is associated with significant morbidity and mortality. Corticoteroid (CORT) therapy is common in the management of HELLP syndrome. This study evaluates the efficacy of CORT therapy to patients with HELLP Syndrome.
MATERIAL AND METHODS: A literature search was carried out in multiple electronic databases. Meta-analyses of means difference and odds ratio were carried under the random-effects model.
RESULTS: Fifteen studies (675 CORT treated and 787 control HELLP patients) were included. CORT treatment significantly improved platelet count (mean difference between CORT treated and controls in changes from baseline, MD: 38.08 [15.71, 60.45]×109; p=0.0009), lactic dehydrogenase (LDH) levels (MD: –440 [–760, –120] IU/L; p=0.007), and alanine aminotransferase (ALT) levels (MD: –143.34 [–278.69, –7.99] IU/L; p=0.04) but the decrease in aspartate aminotransferase (AST) levels was not statistically significant (MD: –48.50 [–114.32, 17.32] IU/L; p=0.15). Corticosteroid treatment was also associated with significantly less blood transfusion rate (odds ratio, OR: 0.42 [0.24, 0.76]; p=0.004) and hospital/ICU stay (MD: –1.79 [–3.54, –0.05] days; p=0.04). Maternal mortality (OR: 1.27 [0.45, 3.60]; p=0.65), birth weight (MD: 0.09 [–0.11, 0.28]; p=0.38) and the prevalence of morbid conditions (OR: 0.79 [0.58, 1.08]; p=0.14) did not differ significantly between both groups.
CONCLUSIONS: Corticosteroid administration to HELLP patients improves platelet count, and the serum levels of LDH and ALT, and reduces hospital/ICU stay and blood transfusion rate, but is not significantly associated with better maternal mortality and overall morbidity.
Keywords: Blood Chemical Analysis, Adrenal Cortex Hormones - therapeutic use, Blood Platelets - metabolism, Case-Control Studies, HELLP Syndrome - enzymology, Hemolysis - drug effects, Liver - enzymology, Maternal Mortality, Platelet Count, Pregnancy