Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2021; 9(6): 1259-1270
Published online Feb 26, 2021. doi: 10.12998/wjcc.v9.i6.1259
New indicators in evaluation of hemolysis, elevated liver enzymes, and low platelet syndrome: A case-control study
Su-Ya Kang, Yun Wang, Li-Ping Zhou, Hong Zhang
Su-Ya Kang, Yun Wang, Li-Ping Zhou, Department of Obstetrics, Suzhou Affiliated Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215002, Jiangsu Province, China
Hong Zhang, Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
Author contributions: Kang SY, Wang Y, Zhou LP and Zhang H designed the research study; Kang SY, Wang Y and Zhou LP collected and analyzed the data; Kang SY wrote the manuscript; Zhang H reviewed the writing; All authors have read and approved the manuscript.
Supported by the People’s Well-being Project of Suzhou City, No. SS201710; the Clinical Expert Team Introduction Project of Suzhou City, No. SZYJTD201709; and the Research Project on Maternal and Child Health of Jiangsu Province, No. F202045.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Suzhou Affiliated Hospital of Nanjing Medical University [approval No. (2019)118].
Informed consent statement: All gravidae involved gave informed written consent.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. The authors declare that there is no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Li-Ping Zhou, BSc, Doctor, Department of Obstetrics, Suzhou Affiliated Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 206 Daoqian Street, Gusu District, Suzhou 215002, Jiangsu Province, China.
Received: September 8, 2020
Peer-review started: September 8, 2020
First decision: December 8, 2020
Revised: December 16, 2020
Accepted: January 5, 2021
Article in press: January 5, 2021
Published online: February 26, 2021
Research background

Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a severe complication in the third trimester of pregnancy. It often co-exists and shares some similar pathophysiological changes with preeclampsia (PE), however, the inflammatory reaction of HELLP is stronger. Since HELLP syndrome is life-threatening to both the gravida and the fetus, there is an urgent need for available predictive and prognostic indicators of HELLP.

Research motivation

Recently, new available systemic inflammatory response (SIR) markers from complete blood cell count (CBC), such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), platelet distribution width (PDW) and red cell distribution width (RDW), have been widely implemented in the diagnosis of patients with inflammatory diseases. These indicators have been widely investigated in PE but less analyzed in HELLP syndrome.

Research objectives

To analyze SIR markers in HELLP syndrome patients.

Research methods

A case-control study enrolled 630 cases (210 patients with HELLP syndrome, 210 patients with merely PE, and 210 healthy gravidae [control group]) was conducted. SIR markers such as NLR, RDW, MPV, PDW and PLR were compared among three groups.

Research results

The NLR, MPV, PDW, leukocyte and neutrophil count were highest in the HELLP group, lower in the PE group, and lowest in the control group. The HELLP group had a lower lymphocyte count than both the PE and control groups. The platelet counts and the PLR in the HELLP group were lower than those in the two other groups. RDW values in the HELLP group were higher than both the PE and control groups.

Research conclusions

SIR markers such as NLR, RDW, MPV and PDW were increased in patients with HELLP syndrome, meanwhile the PLR was decreased in these patients.

Research perspectives

Being easily available, these SIR markers from CBC may become predictive and prognostic indicators and even useful additions to the current diagnostic standard of HELLP syndrome if they are confirmed by further more studies.