The serum gamma-glutamyl transpeptidase-to-platelet ratio predicts HELLP syndrome

TL;DR

The study finds that a blood test measuring gamma-glutamyl transpeptidase to platelet ratio (GPR) can predict HELLP syndrome, a serious pregnancy complication.

Contribution

The study introduces GPR as a novel non-invasive predictor for HELLP syndrome and its adverse outcomes during pregnancy.

Findings

GPR levels were significantly higher in late pregnancy and before delivery in HELLP syndrome patients compared to controls.

GPR showed higher predictive accuracy than other markers like AST, ALT, and PLT in detecting HELLP syndrome.

Abnormal GPR elevation was correlated with preterm birth and identified as an independent risk factor for HELLP syndrome.

Abstract

HELLP (Hemolysis, elevated liver enzymes, and low platelets) syndrome is a dangerous obstetric condition that is in great need of simple and inexpensive non-invasive early predictors, but it has been poorly studied. This study was conducted to investigate the predictive role of serum gamma-glutamyl transpeptidase to platelet ratio (GPR) during pregnancy in HELLP syndrome and its adverse pregnancy outcomes.

This was a retrospective study in a tertiary hospital. One hundred parturients were allocated into two groups: HELLP group (n = 50) and control group (n = 50).

① In the HELLP group, the maternal GPR levels showed a continuous upward trend from middle pregnancy to before-delivery, with significantly higher values observed in late pregnancy and before-delivery compared to the control group (P < 0.05). ② A comparison was made between the counts of platelets (PLT), plasma fibrinogen (FIB), alanine transaminase (ALT), aspartate transaminase (AST), uric acid (UA), γ-glutamyl transferase (GGT), and GPR in two groups of the pregnant women during their late pregnancy and before-delivery to the hospital, all of which showed statistically significant differences (P < 0.05). ③Multivariate logistic regression analysis showed that higher GPR, ALT, and UA were independent risk factors for the development of HELLP syndrome (OR = 23.382, 1.169,1.016, P < 0.05), while higher FIB was a protective factor (OR = 0.057, P < 0.05). ④ Spearman correlation analysis indicated that the abnormal elevation of GPR in late pregnancy and before-delivery was correlated with preterm birth (r = 0.510, 0.450, P < 0.05). ⑤ROC curve analysis revealed that the predictive efficacy of GPR in late pregnancy (AUC = 0.8441) was higher than AST (AUC = 0.7960), ALT (AUC = 0.7952), and PLT (AUC = 0.7691) in late pregnancy, with an AUC of 0.8656 for GPR before delivery When GPR values were 0.22 and 0.27 in late pregnancy and before-delivery, the sensitivity for predicting HELLP syndrome was 77.6% and 78%, and the specificity was 85% and 90%.

The abnormal increase of GPR during pregnancy has a certain predictive effect on HELLP syndrome and its adverse pregnancy outcomes.

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