Intensive care patients with preeclampsia – Clinical risk factors and biomarkers for oxidative stress and angiogenic imbalance as discriminators for severe disease

ElsevierVolume 30, December 2022, Pages 88-94Pregnancy HypertensionHighlights•

Intensive care patients with severe preeclampsia showed more clinical risk factors.

Hemopexin and A1M were lower as a sign of insufficient response to oxidative stress.

Intensive care patients showed high postpartum ratios of sFlt-1/PIGF.

AbstractBackground

Approximately 180 mothers are treated in Swedish Intensive Care Units (ICU) due to preeclampsia each year. Although several clinical risk factors are known, prediction of critical disease is challenging. Two scavenger proteins, hemopexin (Hpx) and alpha-1-microglobulin (A1M) have been suggested to be associated with the oxidative stress seen in preeclampsia. The ratio of two other biomarkers, soluble fms-like tyrosine kinase (sFlt-1) to placental growth factor (PIGF), is predictive of adverse pregnancy outcomes.

Methods

In total 121 women were included in this study where we compared risk factors for preeclampsia, plasma levels of Hpx and A1M in ICU-patients with preeclampsia (n = 41) compared to uncomplicated preeclampsia cases (n = 40) and normotensive pregnancies (n = 40), with the objective to identify clinical risk patterns for severe disease. The sFlt-1/PIGF ratio was investigated in early and late onset preeclampsia ICU-patients. Blood samples were collected at admission to ICU and within 27 h postpartum for all groups.

Results

Hemopexin and A1M levels were significantly lower in the preeclampsia ICU-cohort compared to uncomplicated preeclampsia patients. The sFlt-1/PIGF-ratio was elevated in the ICU-patients but there was no difference between early and late onset preeclampsia. The ICU-patients had more clinical risk factors, refractory hypertension, and an increased rate of emergency Caesarean section.

Conclusion

Intensive care patients have more clinical risk factors and a Hpx and A1M profile suggestive of depletion and thereby a reduced capacity to respond to oxidative stress. The ratios of sFlt-1/PIGF were high in the ICU-cohort and in accordance with pre-delivery levels predictive of adverse pregnancy outcomes.

AbbreviationssFlt-1

Soluble fms-like tyrosine kinase-1

PIGF

Placental growth factor

SIR

Swedish intensive care register

HELLP

Hemolysis elevated liver enzymes low platelets

STBEV

Syncytiotrophoblast extracellular vesicles

SWECRIT biobank

Blood samples from critically ill patients and healthy controls in Sweden

PASIVA

Patient administrative system for intensive care units

Keywords

Hemopexin

Alpha-1-microglobulin

sFlt-1

PIGF

© 2022 The Author(s). Published by Elsevier B.V. on behalf of International Society for the Study of Hypertension in Pregnancy.

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