Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuifuyuan 1, Wangfujing, Beijing, 100730, China.
Department of Nephrology, Second Hospital of Lanzhou University, Lanzhou, 730030, China.
Int Urol Nephrol. 2019 Jul;51(7):1199-1206. doi: 10.1007/s11255-019-02111-7. Epub 2019 Apr 15.
To evaluate the risk factors and renal prognosis of acute kidney injury (AKI) in patients with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome.
Women with HELLP syndrome over a 15-year period at Peking Union Medical College Hospital, China, were retrospectively studied.
A total of 108 patients with HELLP syndrome were included. Fifty-two (48.1%) patients were diagnosed with AKI (median serum creatinine, 139.72 µmol/L; range, 89.00-866.00); 11 (21.2%) required hemodialysis. The AKI group had significantly more multiparity (p = 0.034), hemorrhage > 400 mL (p = 0.027), severe systolic hypertension ≥ 160 mmHg (p = 0.005), infection (p < 0.001), and low hemoglobin (p = 0.002) than non-AKI patients. Multivariate logistic regression showed that infection (OR 36.441, 95% CI 3.819-347.732, p = 0.002), severe systolic hypertension (OR 5.295, 95% CI 1.795-15.620, p = 0.003), and low hemoglobin (OR 0.960, 95% CI 0.932-0.988, p = 0.006) were independent risk factors for AKI. Six patients with AKI died (mortality rate: 11.5%); no death occurred among patients without AKI. In addition to infection (OR 16.268, CI 1.334-198.385, p = 0.029) and eclampsia (OR 69.895, CI 2.834-1723.910, p = 0.009), elevated serum creatinine (OR 1.006, CI 1.001-1.011, p = 0.031) was an independent predictor of maternal mortality. Renal function in 43 (82.7%) patients completely recovered. Two (3.8%) patients developed chronic renal dysfunction after 1 to 2 years of follow-up.
Elevated creatinine was an independent predictor of maternal mortality in HELLP syndrome. AKI severely affects renal prognosis and mortality in pregnant women. The occurrence of AKI was related to infection, severe hypertension, and renal ischemia.
评估溶血、肝酶升高和血小板减少（HELLP）综合征患者急性肾损伤（AKI）的危险因素和肾脏预后。
回顾性研究了中国北京协和医学院医院 15 年间的 HELLP 综合征患者。
共纳入 108 例 HELLP 综合征患者，其中 52 例（48.1%）诊断为 AKI（中位数血清肌酐 139.72µmol/L；范围 89.00-866.00）；11 例（21.2%）需要血液透析。AKI 组多胎妊娠（p=0.034）、出血>400mL（p=0.027）、严重收缩压≥160mmHg（p=0.005）、感染（p<0.001）和血红蛋白低（p=0.002）的比例明显高于非 AKI 患者。多变量逻辑回归显示，感染（OR 36.441，95%CI 3.819-347.732，p=0.002）、严重收缩压（OR 5.295，95%CI 1.795-15.620，p=0.003）和血红蛋白低（OR 0.960，95%CI 0.932-0.988，p=0.006）是 AKI 的独立危险因素。6 例 AKI 患者死亡（死亡率：11.5%）；无 AKI 患者死亡。除感染（OR 16.268，CI 1.334-198.385，p=0.029）和子痫（OR 69.895，CI 2.834-1723.910，p=0.009）外，血清肌酐升高（OR 1.006，CI 1.001-1.011，p=0.031）是产妇死亡的独立预测因素。43 例（82.7%）患者肾功能完全恢复。2 例（3.8%）患者在随访 1-2 年后出现慢性肾功能不全。
血清肌酐升高是 HELLP 综合征产妇死亡的独立预测因素。AKI 严重影响孕妇的肾脏预后和死亡率。AKI 的发生与感染、严重高血压和肾脏缺血有关。
