Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
J Matern Fetal Neonatal Med. 2022 Sep;35(17):3259-3269. doi: 10.1080/14767058.2020.1818200. Epub 2020 Sep 15.
Disseminated Intravascular Coagulation (DIC) is a life-threatening condition. Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome is one of the obstetrical syndromes mostly associated with DIC and thus, high rates of fatal complications. There is a lack of information regarding epidemiologic and clinical characteristics of women who developed HELLP syndrome with and without DIC. Additionally, until now, there is no adapted and widely accepted way to diagnose DIC among pregnant women presenting with HELLP syndrome, despite the evident maternal mortality linked to the disease.
This was a population-based retrospective cohort study, including all women who delivered at the Soroka University Medical Center between the years 2001-2017. The study population was divided into three groups: (1) comparison group ( = 207,266 deliveries); (2) HELLP syndrome without DIC ( = 320); (3) HELLP syndrome with DIC ( = 21). The diagnosis of DIC was based on the ICD-9 code as recorded in the obstetrical database of the Soroka University Medical Center. The coding is based on the diagnosis made by the attending physician during hospitalization.
(1) The rate of HELLP syndrome in the study population was 0.16% (341/207,607), of them 6.16% (21/341) had DIC; (2) among patients with HELLP syndrome, those with DIC had a higher median gravidity and parity; (3) a higher rate of severe maternal morbidity including blood product transfusion, placental abruption, eclampsia, acute renal failure and maternal death was observed in those who had HELLP syndrome and DIC compared to those with HELLP syndrome without DIC and the comparison group (-value <.001 for comparison among the three groups); (4) among women with HELLP syndrome, those with DIC had a longer median PT difference, higher serum creatinine and lower AST as well as ALT median concentrations than those without DIC; (5) patients with HELLP syndrome and DIC had a higher rate of stillbirth and postpartum death than patients in the other groups (-value <.001 for comparison among the three groups); and (6) placental abruption was an independent risk factor for the development of DIC in women with HELLP syndrome (-value <.001).
(1) Among women with HELLP syndrome, those who developed DIC had a higher rate of maternal and neonatal morbidity and mortality than those without DIC; and (2) placental abruption, but not abnormal liver function, was an independent risk factor for the development of DIC in women with HELLP syndrome.
弥散性血管内凝血（DIC）是一种危及生命的病症。溶血性贫血、肝酶升高和血小板减少（HELLP）综合征是与 DIC 关系最密切的产科综合征之一，因此存在较高的致命并发症发生率。对于发生 HELLP 综合征伴或不伴 DIC 的女性，其流行病学和临床特征的信息相对缺乏。此外，尽管该病与产妇死亡率明显相关，但目前仍缺乏针对伴 HELLP 综合征孕妇 DIC 的诊断标准。
（1）阐明 HELLP 综合征伴 DIC 患者的流行率、流行病学和临床特征方面的知识空白；（2）确定 HELLP 综合征患者发生 DIC 的危险因素。
这是一项基于人群的回顾性队列研究，纳入了 2001 年至 2017 年间在索罗卡大学医学中心分娩的所有女性。研究人群分为三组：（1）对照组（ = 207,266 例分娩）；（2）无 DIC 的 HELLP 综合征（ = 320 例）；（3）有 DIC 的 HELLP 综合征（ = 21 例）。DIC 的诊断基于 Soroka 大学医学中心产科数据库中记录的 ICD-9 代码。该编码基于住院期间主治医生的诊断。
（1）研究人群中 HELLP 综合征的发生率为 0.16%（341/207,607），其中 6.16%（21/341）有 DIC；（2）在 HELLP 综合征患者中，有 DIC 的患者的中位孕次和产次更高；（3）与无 DIC 的 HELLP 综合征患者和对照组相比，HELLP 综合征伴 DIC 的患者发生严重产妇发病率的比率更高，包括输血病历、胎盘早剥、子痫、急性肾衰竭和产妇死亡（各组之间的 - 值<.001）；（4）在 HELLP 综合征患者中，有 DIC 的患者的中位 PT 差值更长，血清肌酐水平更高，AST 和 ALT 中位数浓度更低；（5）与其他两组相比，HELLP 综合征伴 DIC 的患者的死胎和产后死亡率更高（各组之间的 - 值<.001）；（6）胎盘早剥是 HELLP 综合征患者发生 DIC 的独立危险因素（-值<.001）。
（1）在 HELLP 综合征患者中，发生 DIC 的患者比无 DIC 的患者具有更高的母婴发病率和死亡率；（2）胎盘早剥而不是肝功能异常是 HELLP 综合征患者发生 DIC 的独立危险因素。
