Estimación de riesgo de daño hepático en mujeres con preeclampsia y síndrome de HELLP en la Maternidad Ángela Loayza de Ollague (2021-2025)

Abstract

Introduction: Preeclampsia and HELLP syndrome are severe pregnancy complications that can lead to significant liver damage. Evaluating this compromise is crucial for clinical management. Objective: The present research aimed to determine the risk of liver involvement in women with preeclampsia and HELLP syndrome, through the analysis of hepatic biomarkers and the application of the FIB-4 index, at Maternidad Ángela Loayza de Ollagüe (2021-2025), for early and effective intervention. Methodology: A retrospective, descriptive, correlational, and quantitative study was conducted, analyzing 184 medical records (2021-2025). Liver damage was assessed using serum biomarkers (ALT, AST, LDH, bilirubin, alkaline phosphatase) and the FIB-4 index. Kruskal-Wallis and chi-squared statistical tests were employed. Results: A significant association was found between the severity of preeclampsia/HELLP and biomarker levels. Patients with complete HELLP showed significantly higher ALT (median: 102 U/L; p < 0.001), AST (142 U/L; p < 0.001), LDH (736 U/L; p < 0.001), total bilirubin (1.06 mg/dL; p = 0.003), direct bilirubin (0.500 mg/dL; p = 0.008), and indirect bilirubin (0.480 mg/dL; p = 0.004). Alkaline phosphatase was not significant (p = 0.167). The FIB-4 index was useful for estimating fibrosis risk: all patients with complete HELLP showed high risk values (>2.67), indicating severe damage, while in mild/severe preeclampsia, low risk (<1.30) predominated. A significant association was observed between trimester and FIB-4 (p = 0.004). No significant association of FIB-4 with age, parity (p = 0.716), residence (p = 0.298) or comorbidities (p = 0.825). Conclusion: The FIB-4 index is validated as a non-invasive, accessible, and effective diagnostic tool for early detection and risk stratification of liver damage in pregnant women with hypertensive disorders. Its integration into standard prenatal care protocols is recommended to optimize management and improve maternal-fetal outcomes.