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. 2014 Nov 25:4:36.
doi: 10.1186/s13613-014-0036-6. eCollection 2014.

Postpartum acute renal failure: a multicenter study of risk factors in patients admitted to ICU

Marie Jonard  1 , Anne-Sophie Ducloy-Bouthors  2 , Eileen Boyle  3 , Maryse Aucourt  4 , Gaelle Gasan  4 , Merce Jourdain  1 , Virginie Mignaux  5 , Nadia Tillouche  6 , François Fourrier  1
Affiliations

Postpartum acute renal failure: a multicenter study of risk factors in patients admitted to ICU

Marie Jonard et al. Ann Intensive Care. .

Abstract

Background: Even in developed countries, severe specific pregnancy complications may occur in the immediate postpartum period and require admission to the ICU. The characteristics and risk factors of acute renal failure (ARF) induced by these complications and their treatments are not well known.

Methods: We performed a retrospective multicenter study in three intensive care departments linked to level III maternity wards in the north of France. All patients admitted to ICU for postpartum complications over a 5-year period (2008 to 2012) were included. Clinical and biological data, delivery characteristics, type of complications, and treatments were compared by univariate and multivariate analyses according to the occurrence and severity of ARF.

Results: One hundred eighty-two patients admitted to ICU for postpartum complications were included in the study. Sixty-eight patients (37%) developed an ARF: 49 with a low or medium severity and 19 with a severe ARF requiring renal replacement therapy. Hemolysis, elevated liver enzyme, and low platelet count (HELLP) syndrome on its own (p = 0.047) or combined with postpartum haemorrhage (p = 0.003), previous treatment by hyperoncotic albumin infusion (p = 0.001) and blockade of fibrinolysis by tranexamic acid (p = 0.03), was associated with secondary ARF. By multivariate analysis, the only independent factors were the association of HELLP syndrome with postpartum haemorrhage and the use of hyperoncotic albumin infusion.

Conclusions: HELLP syndrome associated with postpartum haemorrhage induces a high risk of ARF in the complicated postpartum setting. A particular attention should be given to treatments that could worsen the kidney function in that situation.

Keywords: Acute renal failure; HELLP syndrome; Hyperoncotic albumin; Intensive care; Postpartum complications; Postpartum haemorrhage; Pregnancy; Tranexamic acid.

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Figures

Figure 1
Figure 1
Flowchart of the cohort.
Figure 2
Figure 2
Flowchart of the 103 patients admitted in the ICU for preeclampsia. Data are given in number. Numbers in bracket represent the number of patients with ARF versus patients without ARF and the p value between ARF and no ARF group. PPH: postpartum hemorrhage.
See this image and copyright information in PMC

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