Evaluation of hemolysis as a severe feature of preeclampsia

Richard Burwick, Monica Rincon, Sridivya S. Beeraka, Megha Gupta, Bruce B. Feinberg

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Hemolysis predisposes to adverse pregnancy outcomes. Yet, there are limited data on hemolysis in hypertensive disorders of pregnancy other than hemolysis, elevated liver enzymes, and low platelet count syndrome. To evaluate the prevalence and impact of hemolysis in hypertensive disorders of pregnancy, we performed a retrospective cohort study at a single center (October 2013-May 2017), among women screened for hemolysis using lactate dehydrogenase (LDH) levels. We compared LDH levels by hypertensive disorder (chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia with severe features) and evaluated impact on adverse pregnancy outcomes. Data were analyzed by χ2 or t test, ANOVA, test of medians, and logistic regression. Among 8645 deliveries, 1188 (13.7%) had a hypertensive disorder. Of these, 812 (68.4%) had LDH measurement before delivery: Chronic hypertension (n=152); gestational hypertension (n=209); preeclampsia (n=216); and preeclampsia with severe features (n=235). LDH ≥400 U/L (≥1.6× normal) was more common in preeclampsia with severe features compared with other hypertensive disorders of pregnancy (9.8% versus 2.3%; P<0.001); adjusted odds ratio 4.52 (95% confidence interval, 2.2-9.2; P<0.001). LDH ≥400 U/L was associated with adverse maternal outcomes (41.7% versus 15.3%; P<0.001), adjusted odds ratio 3.05 (95% confidence interval, 1.4-6.7; P=0.006), and adverse neonatal outcomes (eg, preterm birth 59.4% versus 22.5%; P<0.001). We find that elevated LDH levels are associated with adverse maternal and neonatal outcomes in hypertension and preeclampsia, independent of hemolysis, elevated liver enzymes, and low platelet count syndrome. Therefore, elevated LDH levels (≥1.6× normal or ≥400 U/L) may be considered a severe feature of preeclampsia.

Original languageEnglish (US)
Pages (from-to)460-465
Number of pages6
JournalHypertension
Volume72
Issue number2
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Hemolysis
Pre-Eclampsia
L-Lactate Dehydrogenase
Pregnancy Induced Hypertension
Pregnancy Outcome
Hypertension
Platelet Count
Pregnancy
Odds Ratio
Mothers
Confidence Intervals
Liver
Premature Birth
Enzymes
Analysis of Variance
Cohort Studies
Retrospective Studies
Logistic Models

Keywords

  • Hemolysis
  • Hypertension
  • Preeclampsia
  • Pregnancy
  • Thrombotic microangiopathy

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Burwick, R., Rincon, M., Beeraka, S. S., Gupta, M., & Feinberg, B. B. (2018). Evaluation of hemolysis as a severe feature of preeclampsia. Hypertension, 72(2), 460-465. https://doi.org/10.1161/HYPERTENSIONAHA.118.11211

Evaluation of hemolysis as a severe feature of preeclampsia. / Burwick, Richard; Rincon, Monica; Beeraka, Sridivya S.; Gupta, Megha; Feinberg, Bruce B.

In: Hypertension, Vol. 72, No. 2, 01.01.2018, p. 460-465.

Research output: Contribution to journalArticle

Burwick, R, Rincon, M, Beeraka, SS, Gupta, M & Feinberg, BB 2018, 'Evaluation of hemolysis as a severe feature of preeclampsia', Hypertension, vol. 72, no. 2, pp. 460-465. https://doi.org/10.1161/HYPERTENSIONAHA.118.11211
Burwick R, Rincon M, Beeraka SS, Gupta M, Feinberg BB. Evaluation of hemolysis as a severe feature of preeclampsia. Hypertension. 2018 Jan 1;72(2):460-465. https://doi.org/10.1161/HYPERTENSIONAHA.118.11211
Burwick, Richard ; Rincon, Monica ; Beeraka, Sridivya S. ; Gupta, Megha ; Feinberg, Bruce B. / Evaluation of hemolysis as a severe feature of preeclampsia. In: Hypertension. 2018 ; Vol. 72, No. 2. pp. 460-465.
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