Viruses (Sep 2021)

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

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

DOI
https://doi.org/10.3390/v13101906
Journal volume & issue
Vol. 13, no. 10
p. 1906

Abstract

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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.

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