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

• Published in: Viruses 2021-09, Vol.13 (10), p.1906
• Main Authors: Espino-Y-Sosa, Salvador, Martinez-Portilla, Raigam Jafet, Torres-Torres, Johnatan, Solis-Paredes, Juan Mario, Estrada-Gutierrez, Guadalupe, Hernandez-Pacheco, Jose Antonio, Espejel-Nuñez, Aurora, Mateu-Rogell, Paloma, Juarez-Reyes, Angeles, Lopez-Ceh, Francisco Eduardo, Villafan-Bernal, Jose Rafael, Rojas-Zepeda, Lourdes, Guzman-Guzman, Iris Paola, Poon, Liona C
• Format: Article
• Language: English
• Subjects: 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; Critical Illness; Death; Enzymes; Female; Humans; Hypoxia; Infections; Intubation; maternal death; Maternal mortality; Mexico - epidemiology; Pathogenesis; Placenta - metabolism; Plasma; Pneumonia; Pre-Eclampsia; Preeclampsia; Pregnancy; Pregnant Women; Prospective Studies; Protein-tyrosine kinase; Proteins; Renin; Respiratory distress syndrome; SARS-CoV-2 - metabolism; SARS-CoV-2 - pathogenicity; Sepsis; Severe acute respiratory syndrome coronavirus 2; sFlt-1; Vascular Endothelial Growth Factor Receptor-1 - analysis; Vascular Endothelial Growth Factor Receptor-1 - metabolism; Vascular Endothelial Growth Factor Receptor-1 - physiology; Womens health
• ISSN: 1999-4915; 1999-4915
• DOI: 10.3390/v13101906

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; = 0.003), ICU admission (OR: 1.05; = 0.007); intubation (OR: 1.09; = 0.008); sepsis (OR: 1.04; = 0.008); and death (OR: 1.04; = 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.