Risk Factors and Adverse Perinatal Outcomes in Severe Preeclampsia Complicated by HELLP Syndrome

This study investigated the risk factors and adverse perinatal outcomes of severe preeclampsia complicated with HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelet Count syndrome). A total of 170 patients with severe preeclampsia and 30 healthy pregnant women admitted to Wuxi Maternal and Child Health Hospital from January 2020 to October 2023 were enrolled. Of the 170 patients, 30 were complicated by HELLP syndrome and 140 were not; 30 healthy women served as controls. Clinical data, laboratory results, and pregnancy outcomes were compared. Risk factors were analyzed by logistic regression, and predictive efficacy was evaluated by ROC curves. Maternal and neonatal outcomes were assessed, and correlations with risk factors were analyzed. Patients with severe preeclampsia had higher age, BMI, and blood pressure but lower gestational weeks than controls (p < 0.05). In the HELLP group, D-dimer, bilirubin, liver enzymes, and lactate dehydrogenase (LDH) were significantly elevated, while platelets, albumin, and globulin were reduced compared with the non-HELLP group (p < 0.05). Multivariate analysis identified D-dimer and LDH as independent risk factors. ROC analysis showed AUCs of 0.929 for D-dimer, 0.937 for LDH, and 0.956 for their combination, with cutoffs of 3.26 mg/L and 261.60 U/L, yielding 94.4% sensitivity and 92.6% specificity. Adverse outcomes, including stillbirth, preterm labor, neonatal asphyxia, and MICU transfer, were more frequent in HELLP patients (p < 0.05). Elevated D-dimer and LDH correlated with fetal growth restriction and neonatal asphyxia. In conclusion, D-dimer and LDH are independent predictors of HELLP syndrome and adverse perinatal outcomes.