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Investigating hemolysis, elevated liver enzymes and low platelet count in preeclampsia: A case-control study in Ghana
Martin Awe Akilla1, Ignatius Abowini Nchor Awinibuno1, Moses Banyeh1
1Department of Biomedical Laboratory Science University for Development Studies Tamale Ghana.
Insights
Preeclampsia and HELLP syndrome are serious risks for pregnant women. This study found elevated liver enzymes (ALT) can help predict preeclampsia in Ghana, though HELLP syndrome frequency was low.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Biochemistry
Background:
- Preeclampsia significantly increases the risk of Hemolysis, Elevated Liver enzymes, and Low Platelets (HELLP) syndrome, posing dangers to mothers and newborns.
- HELLP syndrome is more prevalent in preeclamptic pregnancies than normotensive ones, but its incidence in preeclampsia in Ghana is understudied.
- The predictive capacity of serum erythrocyte adenylate kinase (EAK) for preeclampsia onset is largely unknown.
Purpose of the Study:
- To investigate the frequency of HELLP syndrome in preeclamptic women in Ghana.
- To evaluate the predictive value of serum erythrocyte adenylate kinase (EAK) for preeclampsia.
- To compare the predictive performance of liver enzymes, specifically alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) in preeclampsia.
Main Methods:
- A case-control study was conducted from May 2020 to April 2022, involving 291 pregnant women (111 with preeclampsia, 180 controls) at two Ghanaian hospitals.
- Blood samples were analyzed for platelet count, AST, ALT, LDH, and EAK using automated analyzers and ELISA.
- HELLP syndrome was diagnosed using the Mississippi triple-class definition.
Main Results:
- Serum ALT levels were significantly higher in the preeclampsia group compared to controls (p < 0.001).
- Mississippi class 3 HELLP syndrome occurred in 1.8% of preeclampsia cases versus 0.6% of controls.
- Serum ALT was a better predictor of preeclampsia than LDH (AUC 0.73 vs. 0.58), with 47.8% sensitivity and 87.2% specificity.
Conclusions:
- While HELLP syndrome occurrence in preeclampsia cases was low in this study, its incidence may increase with rising preeclampsia rates in low- and middle-income countries.
- Serum ALT shows potential as a predictor for preeclampsia in the Ghanaian context.
Background And Aims:
Preeclampsia poses a heightened risk for women, particularly in the development of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, leading to adverse outcomes for both mothers and newborns. The incidence of HELLP syndrome tends to be notably higher among women with preeclampsia compared with those with normotensive pregnancies. However, there is a dearth of research on the frequency of HELLP syndrome within the context of preeclampsia specifically in Ghana. Furthermore, the potential predictive value of serum erythrocyte adenylate kinase (EAK), a marker of hemolysis, in anticipating the onset of preeclampsia remains largely unexplored.
Methods:
Conducted between May 2020 and April 2022, this research employed a case-control methodology at the War Memorial and Upper East Regional Hospitals. A total of 291 pregnant women participated, comprising 111 diagnosed with preeclampsia and 180 control subjects, aged between 18 and 43 years. Venous blood samples were collected and subjected to analysis for platelet count, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and EAK, utilizing automated analyzers, alongside the ELISA technique. Diagnosis of HELLP syndrome was established using the Mississippi triple-class definition.
Results:
The median serum ALT level (with interquartile range) was significantly elevated in the preeclampsia group compared with controls [20.0 (13.7-27.0) vs. 13.0 (9.4-18.6); p < 0.001]. Moreover, the frequency of Mississippi class 3 HELLP syndrome was notably higher among preeclampsia cases (2/111; 1.8%) compared with controls (1/180; 0.6%). Serum ALT emerged as the superior predictor of preeclampsia, outperforming LDH (with an area under the curve of 0.73 compared with 0.58). The sensitivity and specificity of ALT were measured at 47.8% and 87.2%, respectively.
Conclusion:
Although the occurrence of HELLP syndrome in preeclampsia cases appears relatively low, it may escalate as the prevalence of preeclampsia is anticipated to rise in low and middle-income nations.
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