Effect of HELLP syndrome on acute kidney injury in pregnancy and pregnancy outcomes: a systematic review and meta-analys
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RESEARCH ARTICLE
Open Access
Effect of HELLP syndrome on acute kidney injury in pregnancy and pregnancy outcomes: a systematic review and metaanalysis Qiang Liu* , Guan-jun Ling, Shao-quan Zhang, Wen-qing Zhai and Yi-juan Chen
Abstract Background: HELLP syndrome may increase adverse pregnancy outcomes, though the incidence of it is not high. At present, the impact of HELLP syndrome on P-AKI (acute kidney injury during pregnancy) and maternal and infant outcomes is controversial. Thus, we conducted a meta-analysis to find out more about the relationship between HELLP syndrome and P-AKI and pregnancy outcomes. Methods: We systematically searched PubMed, Embassy and Cochrane Databases for cohort studies and RCT to assess the effect of HELLP syndrome on P-AKI and maternal and infant outcomes. Study-specific risk estimates were combined by using fixed-effect or random-effect models. Results: This meta-analysis included 11 cohort studies with a total of 6333 Participants, including 355 cases of pregnant women with HELLP syndrome and 5979 cases that without. HELLP syndrome was associated with relatively higher risk of P-AKI (OR4.87 95% CI 3.31 ~ 7.17, P 40 IU/L), and/or alanine aminotransferase (ALT > 40 IU/L) and low platelet (Plt) count as class III (Plt:100–150 × 10 3 /mL), class II (Plt:50–99 × 10 3 /mL), and class I (Plt < 50 × 10 3 /mL) Abbreviations: CC indicates case–control, RC retrospective cohort, PC prospective cohort, CV cardiovascular AKI Acute kidney injury, a Expressed as total number of patients (number in HELLP group/number in control group)
Turkey
USA
38 (4/34)
Not clear
Quality score
Kidney outcome、 6
132 (20/112)
creatinine level ≥ 1.2 mg/dL and/or oliguria < 400 mL/24 h 156 (10/146)
Sample size of patients Sample size of patients Major clinical with AKI in patients with AKI in patients outcomes with HELLPa without HELLP a
AKI (ARF) was defined
hemolysis, increased diagnosed on an increased creatinine 12 (8/4) liver enzymes and level over 160 umol/1 thrombocytopenia.
Not clear
The criteria of Sibai
The criteria of Sibai
HELLP was defined
China taiwan Hemolysis, elevated liver enzymes, low platelet count
Pakistan
Turkey
Study Country Design
Author, Year
Table 1 Characteristics of the included studies
Liu et al. BMC Pregnancy and Childbirth (2020) 20:657 Page 3 of 9
Liu et al. BMC Pregnancy and Childbirth
(2020) 20:657
Page 4 of 9
Table 2 Characteristics of the included studies Author,Year
Study Country Design
HELLP was defined
Gul 2005 [4]
PC
Turkey
The criteria of Sibai
Abramovici 1999 [20]
RC
Pakistan The criteria of Sibai
Osmanağaoğlu 2004 [21] RC a
Turkey
Sample size of patients with stillbirth in patients with HELLPa
sample size of Major clinical patients with outcomes stillbirth in patients a without HELLP
Quality score
106 (11/95)
261 (12/249)
Fetal outcome 6
133 (10/123)
141 (5/136)
Fetal outcome 6
52 19/23
Fetal outcome 5
Hemolysis, elevated liver 51 enzymes, low platelet count 27/24
Expressed as total number of patients (number in PR-AKI g
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