HELLP syndrome is associated with an increased inflammatory response, which may be inhibited by administration of prednisolone.

Abstract

OBJECTIVE:

To investigate the effect of prednisolone on HELLP syndrome by assessing several markers of the inflammatory response and hepatic damage associated with HELLP syndrome.

DESIGN:

Prospective study.

SETTING:

Single-center, tertiary obstetric care facility at the University Medical Centre Utrecht, The Netherlands.

POPULATION:

Study subjects included normal controls, patients with non-HELLP preeclampsia, and patients with preeclampsia and HELLP syndrome.

METHODS:

HELLP syndrome was defined by hemolysis (serum lactate dehydrogenase [LDH] >600 IU/L and/or haptoglobin <or=0.3 g/L), elevated liver enzymes (serum aspartate aminotransferase [AST] >70 U/L and/or serum alanine aminotransferase [ALT] >70 U/L), and a low platelet count (<100 x 10(9)/L). Blood samples from patients with HELLP syndrome who were receiving either prednisolone or placebo were obtained before, during, and after a HELLP exacerbation in the antepartum period. Plasma levels of CRP, IL-1RA, IL-6, sIL-6R, IL-8, IL-10, TNF-alpha, and GSTA1-1 were determined. Samples from women with preeclampsia but without HELLP syndrome and from healthy pregnant women were included as controls.

MAIN OUTCOME MEASURES:

Plasma levels of CRP, IL-1RA, IL-6, sIL-6R, IL-8, IL-10, TNF-alpha, and GSTA1-1.

RESULTS:

During a HELLP exacerbation CRP, IL-6, IL-1Ra, and GSTA1-1 levels are significantly increased (p < 0.01). In the group of patients treated with prednisolone, significantly lower IL-6 levels were observed during a HELLP exacerbation, compared with patients who did not receive prednisolone (p < 0.01).

CONCLUSION:

HELLP syndrome is associated with an increased inflammatory response. Circulating IL-6 levels in HELLP syndrome are reduced during prednisolone administration, suggesting a stabilizing effect on the inflammatory endothelial process.

• Authors: Pieter J van Runnard Heimel, Annemiek Kavelaars, Cobie J Heijnen, Wilbert H M Peters, Anjoke J M Huisjes, Arie Franx, Hein W Bruinse
• Journal: Hypertension in pregnancy (Hypertens Pregnancy) Vol. 27 Issue 3 Pg. 253-65 ( 2008) ISSN: 1525-6065 [Electronic] England
• PMID: 18696354 (Publication Type: Journal Article)

Chemical References

• Anti-Inflammatory Agents
• Biomarkers
• Prednisolone

Topics

• Adult
• Anti-Inflammatory Agents (therapeutic use)
• Biomarkers (blood)
• Case-Control Studies
• Female
• HELLP Syndrome (blood, drug therapy)
• Humans
• Inflammation (blood, drug therapy)
• Prednisolone (therapeutic use)
• Pregnancy