The Role of Platelet Counts in the Assessment of Inpatient Women With Preeclampsia

Abstract

Objective: Platelet count has been proposed as a screening test for generalized coagulopathy in women with preeclampsia We performed this study to determine the relationship between platelet counts and the risk of abnormal coagulation and adverse maternal outcomes in women with preeclampsia Methods:We used data from women in the PIERS (Pre-eclampsia Integrated Estimate of RiSk) database Abnormal coagulation was de ned as either an international normalized ratio result greater than and/or a serum brinogen level less than the BC Women's Hospital laboratory's pregnancy-speci c normal range The relationship between platelet counts and adverse maternal outcomes was explored using a logistic regression analysis The sensitivity, speci city, positive predictive value, and negative predictive value of platelet counts in identifying abnormal coagulation or adverse maternal outcomes were calculatedReslts: Abnormal coagulation occurred in 105 of 1405 eligible women (75%) The odds of having abnormal coagulation were increased for women with platelet counts < 50 × 10 9 /L (OR 778; 95% CI 336 to 1803) and between 50 and 99 × 10 9 /L (OR 269; 95% CI 144 to 501) compared with women who had platelet counts above 150 × 10 9 /L Platelet counts < 100 × 10 9 /L were associated with signi cantly increased odds of adverse maternal outcomes, most speci cally blood transfusion A platelet count of < 100 × 10 9 /L had good speci city in identifying abnormal coagulation and adverse maternal outcomes (92% [95% CI 91% to 94%] and 92% [95% CI 91% to 94%], respectively), but poor sensitivity (22% [95% CI 15% to 31%] and 16% [95% CI 11% to 23%], respectively) Conclsion: A platelet count < 100 × 10 9 /L is associated with an increased risk of abnormal coagulation and maternal adverse outcomes in women with preeclampsia However, the platelet count should not be used in isolation to guide care because of its poor sensitivity Whether or not a platelet count is normal should not be used to determine whether further coagulation tests are needed Résltats : Une coagulation anormale s'est manifestée chez 105 des 1 405 femmes admissibles (7,5 %) Les risques de présenter une coagulation anormale étaient accrus chez les femmes qui comptaient des numérations plaquettaires < 50 × 10 9 /l (RC,7,78; IC à 95 %,3,03) The Role of Platelet Conts in the Assessment of Inpatient Women With Preeclampsia avec les femmes qui comptaient des numérations plaquettaires se situant au-delà de 150 × 10 9 /l Les numérations plaquettaires < 100 × 10 9 /l ont été associées à une hausse signi cative des risques de connaître des issues maternelles indésirables, plus particulièrement une transfusion sanguine Une numération plaquettaire < 100 × 10 9 /l présentait une bonne spéci cité pour ce qui est de l'identi cation d

Prognostic Role of Maternal Neutrophil Gelatinase-Associated Lipocalin in Women with Severe Early-Onset Preeclampsia

“…However, a subanalysis of their results [36] showed a limited sensitivity (16%; 95% CI 11-23%) of this platelet count threshold for the prediction of maternal complications. Because NGAL is an independent predictor of maternal complications, its combination with the platelet count may improve the predictive capacity of both individual parameters.…”

Preeclampsia: A review of the evidence

“…Similarly when results were stratified into quartiles, there was positive correlation with the higher quartiles for aspartate and alanine transaminases as well as lactate dehydrogenase and the lower quartiles for albumin. [25] However neither change of LFT result within 48 hrs of admission or from admission to delivery nor the rate of change was predictive of adverse outcome.…”

“…However, low platelets count less than 100 × 10 9 /L, raised liver transaminases and creatinine >110 mcmol/L are each associated with adverse maternal outcome. [25,26] The PIERS study enrolled 2008 women with preeclampsia, 1053 had abnormal liver function test. The odds of having adverse maternal outcome were higher in women with any abnormal liver function test than in those with normal results.…”

Preventing deaths due to the hypertensive disorders of pregnancy

“…We have assessed the performance of maternal symptoms, proteinuria, oxygen saturation by pulse oximetry (SpO 2 ), uric acid, platelet counts and liver tests individually to identify those hypertensive pregnant women who are more likely to suffer severe complications [73], [74], [75], [76], [77], [78]. Of these, only SpO 2 showed any capacity as a test that can be used in isolation, including predicting non-cardiorespiratory adverse maternal outcomes (area under the receiver-operator characteristic (AUC ROC) >0.7) [77].…”