Le HELLP syndrome : diagnostic et prise en charge thérapeutique

[Evaluation of D-dimer as a marker for severity in pregnancies with preeclampsia]

OBJECTIVES

Alterations in blood coagulation and fibrinolysis play a major role in the pathogenesis of preeclampsia. HELLP syndrome is associated with hypercoagulability and leads to maternal and perinatal complications. Our purpose was to evaluate D-dimer as a marker for severity in pregnancies with preeclampsia.

PATIENTS AND METHODS

Plasma D-dimer levels were measured using an enzyme-linked immunosorbent assay (ELISA) technique. We studied the association between D-dimer levels and clinical and biological characteristics of pregnancies complicated by preeclampsia.

RESULTS

D-dimer values increased with increasing gestational age. Patients with HELLP syndrome had mean D-dimer values significantly greater than patients with preeclampsia alone (3848±2551 versus 1578±1077, P<0.001). However, the level of D-dimer at the time of admission was poorly predictive of occurrence of HELLP syndrome. Area under of the ROC curve was 0.69 (CI 95%: 0,59-0,79). The best threshold was 2170 ng/mL with a sensitivity of 0.91 and a specificity of 0.40. Other severity criteria of preeclampsia were not associated with higher levels of D-dimer.

DISCUSSION AND CONCLUSION

In preeclamptic patients, D-dimer levels were related with gestational age and HELLP syndrome. However, accuracy of this test to predict occurrence of HELLP syndrome or severe preeclampsia was too low to recommend its use routinely.