Divergent Risk Factors and Outcomes in Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome and Isolated...

The hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome usually occurs in association with preeclampsia (PE). Risk factors and short-term and long-term outcomes of women with PE with HELLP (PE-HELLP) or isolated PE (iPE) are unclear.

Using data from the Cohort of Cardiovascular Diseases in Pregnancy (CONCEPTION) (a French nationwide, population-based, prospective cohort) study, all women who gave birth at ≥22 weeks of gestation between 2010 and 2018 were included. The main outcomes were mortality, cardiovascular, cerebrovascular, thromboembolic events, and renal failure (RF).

Among the 2,829,700 women with first deliveries, 73,736 women with iPE, 9147 women with PE-HELLP and 2,746,817 women controls were studied. Diabetes, chronic hypertension, and obesity were more frequently associated with iPE than PE-HELLP. Social deprivation was positively associated with iPE but negatively associated with PE-HELLP. Chronic inflammatory diseases and lupus were more associated with PE-HELLP than iPE. During the first year, iPE and PE-HELLP constituted major risk factors for hypertension and all other major adverse events versus controls; however, PE-HELLP was a significantly stronger risk of major adverse cardiovascular events (MACEs), stroke, thromboembolism, and RF than iPE. After the first year, iPE remained significantly associated with all outcomes, whereas PE-HELLP was a risk factor only for hypertension and RF versus controls; the risk of RF was similar for iPE and PE-HELLP.

iPE and PE with HELLP differ regarding their risk factors and types and dynamics of their major complications.