Ağaçayak Elif, Bugday Rezan, Peker Nurullah, Deger Ugur, Ölmez Kavak Gönül, Evsen Mehmet Siddik, Gul Talip
Department of Obstetrics and Gynecology, Dicle University School of Medicine, Diyarbakır, Turkey.
Department of Obstetrics and Gynecology, Memorial Hospital, Diyarbakır, Turkey.
Int J Hypertens. 2022 Apr 18;2022:3366879. doi: 10.1155/2022/3366879. eCollection 2022.
The study aimed to compare patients with HELLP syndrome who require intensive care and who do not require intensive care and evaluate the factors affecting the length of stay in the intensive care unit.
Patients were divided into two groups as follows: requiring intensive care (group 1) and not requiring intensive care (group 2). The data of both groups were compared in terms of demographic characteristics, transfusion amounts, length of stay in the intensive care unit, maternal complications, and mortality.
14032 births in a tertiary center between 2011 and 2018 were evaluated in this study. During the study period, 342 patients were diagnosed with HELLP, and 32 (9.4%) of these were followed up in the intensive care unit. The length of stay in the intensive care unit was determined as 8.1 (7.2) days on average. Fresh frozen plasma, erythrocyte suspension, apheresis, and random thrombocyte transfusion were observed to be significantly more in group 1 patients. In the regression analysis, the most effective factor was found to be erythrocyte suspension and the length of stay in the intensive care unit was significantly longer in patients who had erythrocyte suspension transfusion. The receiver operating characteristic curve showed that the area under the curve value for erythrocyte transfusion was 70.6%. When the cutoff value of erythrocyte suspension was 450 (95% CI: 365-681) ml, the sensitivity was 43.8% and the specificity was 91.6%.
We think that physicians should be careful that maternal morbidity and mortality may increase as the need for erythrocyte suspension transfusion increases in patients with HELLP syndrome. Minimum transfusion to hemodynamically stable patients can be more suitable in terms of morbidity and mortality in managing patients with HELLP syndrome requiring erythrocyte suspension transfusion. Precautions and measures should be taken in this regard.
本研究旨在比较需要重症监护和不需要重症监护的HELLP综合征患者，并评估影响重症监护病房住院时间的因素。
患者分为以下两组：需要重症监护（第1组）和不需要重症监护（第2组）。比较两组患者的人口统计学特征、输血量、重症监护病房住院时间、孕产妇并发症和死亡率。
本研究评估了2011年至2018年期间一家三级中心的14032例分娩情况。研究期间，342例患者被诊断为HELLP，其中32例（9.4%）在重症监护病房接受随访。重症监护病房的平均住院时间确定为8.1（7.2）天。观察到第1组患者新鲜冰冻血浆、红细胞悬液、单采和随机血小板输注量明显更多。回归分析发现，最有效的因素是红细胞悬液，接受红细胞悬液输注的患者在重症监护病房的住院时间明显更长。受试者工作特征曲线显示，红细胞输血的曲线下面积值为70.6%。当红细胞悬液的截断值为450（95%CI：365-681）ml时，敏感性为43.8%，特异性为91.6%。
我们认为医生应注意，HELLP综合征患者对红细胞悬液输注的需求增加时，孕产妇发病率和死亡率可能会升高。对于需要红细胞悬液输注的HELLP综合征患者，从发病率和死亡率角度来看，对血流动力学稳定的患者进行最低限度输血可能更合适。应在这方面采取预防措施。
