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.