# 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.

## Key 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.