Choice of glucocorticoid in HELLP syndrome - dexamethasone versus betamethasone: revisiting the dilemma

Abstract

Objective: Maternal corticosteroid administration has been reported to improve the blood pressure, urine output, laboratory values of liver enzymes and platelets in HELLP syndrome. In this controversial subject, recently, Cochrane Database had updated its systematic review and in the subgroup analysis they indicated that dexamethasone was superior to betamethasone for the improvement of platelet counts and liver enzymes. However, there are several issues which need to be clarified about the subgroup analysis and the consequent conclusion. Methods: Systematic review and re-analysis of the indicated studies. Results: In the subgroup analysis two studies were included, which had used non-parametric methods for statistical analysis and yielded insignificant p-values that showed indifference between betamethasone and dexamethasone. However, the Cochrane meta-analysis had used parametric methods in contradistinction to the included studies and indicated significant difference between two steroids. Accordingly, results and conclusions of the Cochrane meta-analysis in this subgroup analysis cannot be justified with the indicated two studies. Conclusion: Here we can only urge further studies to provide frank evidence about the comparison of dexamethasone and betamethasone in HELLP syndrome. Until shown to be true, we doubt the credibility of the subgroup analysis results of the Cochrane review and the application of these subgroup results into clinical practice.