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Hypoalbuminemia Predicts Poor Pregnancy Outcome among Cases of HELLP Syndrome in Nigeria

Background: The current study determined the status of plasma albumin and the relationship between hypoalbuminemia and adverse/poor pregnancy outcomes among cases of HELLP syndrome (HELLPsyn) in Port Harcourt, Nigeria.
Methods: A retrospective cross-sectional study was conducted among women diagnosed with HELLPsyn in the University of Port Harcourt Teaching Hospital (UPTH) between 2011 and 2020. Data of all eligible cases were extracted from hospital registers, case notes, nurses’ charts, laboratory, and medical files using pretested datasheet and analyzed.
Results: Two hundred and ten (210) HELLPsyn cases certified the eligible criteria and were included in the analysis. The overall hypoalbuminemia was recorded among 140(66.6%) of which 73(52.1%) and 67(47.9%) were in the clinically significant hypoalbuminemic and clinically insignificant hypoalbuminemic subgroups, respectively. The overall hypoalbuminemia and the clinically significant hypoalbuminemia subtype were more predominant among the severe HELLPsyn cases. The clinically significant hypoalbuminemic HELLP cases had increased risk of acute kidney injury (OR:8.456;95%CI:6.854-11.345), sepsis/infection (OR:4.346;95%CI:2.761-6.709), intensive care unit admission (OR:6.412;95%CI:4.356-8.104), and emergency cesarean section (OR:2.308;95%CI:1.206-3.896) compared to the normoalbuminemic/clinically insignificant hypoalbuminemic HELLP cases. Offspring of the clinically significant hypoalbuminemic HELLP cases also had increased risk of preterm delivery (OR:6.843;95%CI:4.346-8.766), intrauterine growth restriction (OR:3.408;95%CI: 2.166-4.988), birth asphyxia (OR:5.233;95%CI:3.764-7.412), and special care baby unit admission (OR:2.077;95%CI:1.106-3.674) compared to the normoalbuminemic/clinically insignificant hypoalbuminemic HELLP cases.
Conclusion: Hypoalbuminemia, especially the clinically significant hypoalbuminemia subtype, is associated with adverse/poor maternal and perinatal outcomes among cases of HELLPsyn. However, we recommend further studies with a robust design to evaluate the clinical relevance of our findings.

Key words: KHELLP syndrome, hypoalbuminemia, clinically significant hypoalbuminemia.