Divergent Risk Factors and Outcomes in Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome and Isolated Preeclampsia
In brief
HELLP variant of preeclampsia drives markedly higher early cardiovascular, stroke and clot risk than isolated preeclampsia
In a French nationwide cohort of nearly 3 million deliveries, women with preeclampsia plus HELLP had substantially greater odds of major cardiovascular events, stroke, thromboembolism and renal failure in the first year after delivery compared with those with isolated preeclampsia. After one year, the excess risk persisted for hypertension and renal failure but not for the other outcomes, highlighting the need for intensified early monitoring of women with PE-HELLP.
- Journal
- Kidney international reports (Q1)
- Published
- 22 June 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Jean-Michel Halimi, Grégory Lailler, Valentin Maisons, Bénédicte Sautenet, Laurent Fauchier, Jean-Baptiste de Fréminville, et al.
- PMID
- 42502666
- DOI
- 10.1016/j.ekir.2026.106681
Why clinicians should know about it
- Picked for Rheumatology (paper of the day, 27 July 2026): Trochleoplasty and long‑term patellofemoral arthritis
Abstract
INTRODUCTION: The hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome usually occurs in association with preeclampsia (PE). Risk factors and short-term and long-term outcomes of women with PE with HELLP (PE-HELLP) or isolated PE (iPE) are unclear. METHODS: Using data from the Cohort of Cardiovascular Diseases in Pregnancy (CONCEPTION) (a French nationwide, population-based, prospective cohort) study, all women who gave birth at ≥22 weeks of gestation between 2010 and 2018 were included. The main outcomes were mortality, cardiovascular, cerebrovascular, thromboembolic events, and renal failure (RF). RESULTS: Among the 2,829,700 women with first deliveries, 73,736 women with iPE, 9147 women with PE-HELLP and 2,746,817 women controls were studied. Diabetes, chronic hypertension, and obesity were more frequently associated with iPE than PE-HELLP. Social deprivation was positively associated with iPE but negatively associated with PE-HELLP. Chronic inflammatory diseases and lupus were more associated with PE-HELLP than iPE. During the first year, iPE and PE-HELLP constituted major risk factors for hypertension and all other major adverse events versus controls; however, PE-HELLP was a significantly stronger risk of major adverse cardiovascular events (MACEs), stroke, thromboembolism, and RF than iPE. After the first year, iPE remained significantly associated with all outcomes, whereas PE-HELLP was a risk factor only for hypertension and RF versus controls; the risk of RF was similar for iPE and PE-HELLP. CONCLUSION: iPE and PE with HELLP differ regarding their risk factors and types and dynamics of their major complications.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.