Corticosteroids for improving patient relevant outcomes in HELLP syndrome: a systematic review and meta-analysis

Abstract

Abstract Background: We conducted this updated systematic review to assess the effects of corticosteroids vs placebo or no treatment for improving patient-relevant outcomes in hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. Methods: CENTRAL, MEDLINE/PubMed, Web of Science, and Scopus, from the date of inception of the databases to September 20, 2023 were searched. Reference lists of included studies and systematic reviews were thoroughly searched. We included RCTs that enrolled women with HELLP syndrome, whether antepartum or postpartum, to receive any corticosteroid versus placebo or no treatment. No language or publication date restrictions were made. We used a dual independent approach for screening titles and abstracts, full text screening, data extraction, and risk of bias assessment. Pairwise meta-analyses were conducted, where two or more studies met methodological criteria for inclusion. GRADE approach was used to assess certainty of evidence for the pre-specified outcomes. Results: Fifteen trials (821 women) compared corticosteroids with placebo or no treatment. The effect of corticosteroids is uncertain for the primary outcome i.e., maternal death (risk ratio [RR] 0.77, 95% confidence interval [CI] 0.25 to 2.38, very low certainty evidence). The effect of corticosteroids is also uncertain for other important outcomes including pulmonary edema, dialysis, liver morbidity (hematoma, rupture, and failure), or perinatal death because of very low certainty evidence. Low certainty evidence suggests that corticosteroids have little or no effect on the need for platelet transfusion and may result in a slight reduction in acute renal failure. Conclusions: In women with HELLP syndrome, the effect of corticosteroids vs placebo or no treatment is uncertain for patient-relevant outcomes including maternal death, maternal morbidity, and perinatal death. These uncertainties regarding this critical question should be addressed by adequately powered rigorous trials. Systematic review registration: Center for Open Science, osf.io/yzku5