Clinical, Laboratory and Radiological Factors associated with posterior reversible encephalopathy syndrome (PRES) in...

Posterior reversible encephalopathy syndrome (PRES) remains a serious neurological complication associated with eclampsia/pre-eclampsia. Early identification remains challenging due to heterogeneous presentations and limited consensus on associated clinical and laboratory factors. Therefore, we aimed to assess clinical and laboratory factors associated with PRES by pooling data from primary studies.

A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Embase, and Web of science were searched from inception to March 25, 2025. Primary outcomes included PRES incidence, while secondary outcomes included biomarkers, maternal and fetal outcomes, and imaging characteristics. Risk of bias was assessed using Newcastle Ottawa's scale and National Institutes of Health (NIH) tool. A random-effects model was employed for meta-analysis.

A total of 28 studies were included. The pooled incidence of PRES was 38.68% (95% CI: 29.63-48.59), with significant heterogeneity (I²=98.5%). Patients with PRES had significantly higher liver enzymes (ALT: MD 35.88 IU/L; AST: MD 48.69 IU/L) and lower platelet counts (MD: -31.15 × 10⁹/L). Total bilirubin was also elevated. Maternal mortality risk was increased but not statistically significant (RR: 4.06), while stillbirth and preterm birth showed no significant associations. Imaging findings commonly involved the frontal (43.05%) and temporal lobes (20.33%).

PRES is a frequent complication of pre-eclampsia and eclampsia, with identifiable clinical and biochemical factors associated with its occurrence, particularly elevated liver enzymes and thrombocytopenia. Despite substantial heterogeneity, these findings may help inform clinical assessment, especially in resource-limited settings. Further high-quality prospective studies are needed to develop standardized predictive models and improve early detection.