Journal Article

Novel Ratio Soluble Fms-like Tyrosine Kinase-1/Angiotensin-II (sFlt-1/ANG-II) in Pregnant Women Is Associated with Critical Illness in COVID-19

Juarez-Reyes, Angeles, Torres-Torres, Johnatan, Guzman-Guzman, Iris Paola, Estrada-Gutierrez, Guadalupe, Rojas-Zepeda, Lourdes, Hernandez-Pacheco, Jose Antonio, Lopez-Ceh, Francisco Eduardo, Villafan-Bernal, Jose Rafael, Espino-y-Sosa, Salvador, Espejel-Nuñez, Aurora, Solis-Paredes, Juan Mario, Poon, Liona C., Martinez-Portilla, Raigam Jafet, Mateu-Rogell, Paloma

2021

Overview

Background: In healthy pregnancies, components of the Renin-Angiotensin system (RAS) are present in the placental villi and contribute to invasion, migration, and angiogenesis. At the same time, soluble fms-like tyrosine kinase 1 (sFlt-1) production is induced after binding of ANG-II to its receptor (AT-1R) in response to hypoxia. As RAS plays an essential role in the pathogenesis of COVID-19, we hypothesized that angiogenic marker (sFlt-1) and RAS components (ANG-II and ACE-2) may be related to adverse outcomes in pregnant women with COVID-19; Methods: Prospective cohort study. Primary outcome was severe pneumonia. Secondary outcomes were ICU admission, intubation, sepsis, and death. Spearman’s Rho test was used to analyze the correlation between sFlt-1 and ANG-II levels. The sFlt-1/ANG-II ratio was determined and the association with each adverse outcome was explored by logistic regression analysis and the prediction was assessed using receiver-operating-curve (ROC); Results: Among 80 pregnant women with COVID-19, the sFlt-1/ANG-II ratio was associated with an increased probability of severe pneumonia (odds ratio [OR]: 1.31; p = 0.003), ICU admission (OR: 1.05; p = 0.007); intubation (OR: 1.09; p = 0.008); sepsis (OR: 1.04; p = 0.008); and death (OR: 1.04; p = 0.018); Conclusion: sFlt-1/ANG-II ratio is a good predictor of adverse events such as pneumonia, ICU admission, intubation, sepsis, and death in pregnant women with COVID-19.

• Publisher: MDPI AG,MDPI
• Subject: Adult / Angiogenesis / Angiotensin / Angiotensin II / Angiotensin II - analysis / Angiotensin II - metabolism / Angiotensin II - physiology / Biomarkers / Blood / Brief Report / Cohort Studies / Coronaviruses / COVID-19 / COVID-19 - complications / COVID-19 - metabolism / COVID-19 infection / Critical Illness / Death / Enzymes / Female / Humans / Hypoxia / Infections / Intubation / maternal death / Maternal mortality / Mexico - epidemiology / odds ratio / Pathogenesis / Placenta - metabolism / Plasma / Pneumonia / Pre-Eclampsia / prediction / Preeclampsia / Pregnancy / Pregnant Women / Prospective Studies / Protein-tyrosine kinase / Proteins / regression analysis / Renin / renin-angiotensin system / Respiratory distress syndrome / SARS-CoV-2 - metabolism / SARS-CoV-2 - pathogenicity / Sepsis / Severe acute respiratory syndrome coronavirus 2 / sFlt-1 / tyrosine / Vascular Endothelial Growth Factor Receptor-1 - analysis / Vascular Endothelial Growth Factor Receptor-1 - metabolism / Vascular Endothelial Growth Factor Receptor-1 - physiology / Womens health