Strength and Limitations:
One major strength of our study is the strict use of inclusion criteria. Only patients matching all Mississippi or Tennessee criteria for HELLP syndrome were included in our study. Additionally, AFLP was only diagnosed when at least six Swansea criteria out of 15 were present. A limitation is the relatively small sample size of cases with AFLP. However, considering the rarity of the disease and the striking difference in particular of sFlt-1 between the groups we are confident that our findings together with the observation by Suzuki et al and Neuman et al. may elucidate that pregnancies compromised by AFLP show a different angiogenic pattern compared with other liver-associated pregnancy complications. Despite the enormous effort, prospective studies are eagerly needed to corroborate our findings.