Early risk assessment of severe preeclampsia: Admission battery of symptoms and laboratory tests to predict likelihood of subsequent significant maternal morbidity

OBJECTIVE: This study was undertaken to investigate the utility of an admis sion battery of findings and laboratory data in the discrimination of patie nts with severe preeclampsia with or without HELLP (hemolysis, elevated liv er enzyme levels, and low platelet count) syndrome at high risk for develop ment of significant maternal morbidity. STUDY DESIGN: The clinical and laboratory findings at hospital admission fo r 970 patients with severe preeclampsia with or without HELLP syndrome were studied retrospectively to develop parameters associated with low, moderat e, and high risks for the subsequent development of significant maternal mo rbidity involving the hematologic and coagulation, cardiopulmonary, and hep atorenal systems. RESULTS: Nausea and vomiting and epigastric pain are independent risk facto rs for complicated severe preeclampsia. Results of a panel of tests with va lues including lactate dehydrogenase level >1400 IU/L, aspartate aminotrans ferase level >150 IU/L, alanine aminotransferase level >100 IU/L, uric acid level 17.8 mg/dL, serum creatinine level >1.0 mg/dL, and 4+ urinary protei n by dipstick can be used to discriminate the patient at high risk for sign ificant maternal morbidity. Concentrations of lactate dehydrogenase, aspart ate aminotransferase, and uric acid above these cut points have the stronge st predictive value and are risk additive with worsening thrombocytopenia. CONCLUSION: The presence of nausea and vomiting, epigastric pain, or both i n association with admission laboratory values that are in excess of the cu toffs for lactate dehydrogenase, aspartate aminotransferase, and uric acid concentrations or for all 6 tests is predictive of high risk of morbidity f or the patient with severe preeclampsia. These factors are independent of a nd additive with the rising maternal risk associated with decreasing platel et count.