Hernandez-Pacheco Jose Antonio, Torres-Torres Johnatan, Martinez-Portilla Raigam Jafet, Solis-Paredes Juan Mario, Estrada-Gutierrez Guadalupe, Mateu-Rogell Paloma, Nares-Torices Miguel Angel, Lopez-Marenco Mario Enmanuel, Escobedo-Segura Keren Rachel, Posadas-Nava Alejandro, Villafan-Bernal Jose Rafael, Rojas-Zepeda Lourdes, Becerra-Navarro Norma Patricia, Casillas-Barrera Manuel, Pichardo-Cuevas Mauricio, Muñoz-Manrique Cinthya, Cortes-Ramirez Ivan Alonso, Espino-Y-Sosa Salvador
Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico.
Hospital de la Mujer, Mexico City, Mexico.
Front Med (Lausanne). 2022 May 9;9:894633. doi: 10.3389/fmed.2022.894633. eCollection 2022.
Preeclampsia (PE) and COVID-19 share a common vascular-endothelial physiopathological pathway that may aggravate or worsen women's outcomes when both coexist. This study aims to evaluate the association of sFlt-1 levels and adverse maternal outcomes among positive SARS-CoV-2 pregnant women with and without hypertensive disorders of pregnancy (HDP).
We performed a multicenter retrospective cohort study of pregnant women with confirmed SARS-CoV-2 infection that required hospital admission. The exposed cohort comprised women with a diagnosis of an HDP. The primary outcome was a composite definition of adverse maternal outcome. The association between predictors and the main and secondary outcomes was assessed using an elastic-net regression which comprised a Lasso and Ridge regression method for automatic variable selection and penalization of non-statistically significant coefficients using a 10-fold cross-validation where the best model if automatically chosen by the lowest Akaike information criterion (AIC) and Bayesian information criteria (BIC).
Among 148 pregnant women with COVID-19, the best predictive model comprised sFlt-1 MoMs [odds ratio (OR): 5.13; 95% CI: 2.19-12.05], and HDP (OR: 32.76; 95% CI: 5.24-205). sFlt-1 MoMs were independently associated with an increased probability of an adverse maternal outcome despite adjusting for HDP.
Our study shows that sFlt-1 is an independent predictor of adverse outcomes in women with SARS-CoV-2 despite hypertension status.
子痫前期（PE）和新型冠状病毒肺炎（COVID-19）具有共同的血管内皮生理病理途径，当两者共存时可能会加重或恶化女性的预后。本研究旨在评估严重急性呼吸综合征冠状病毒2（SARS-CoV-2）检测呈阳性的孕妇中，可溶性血管内皮生长因子受体-1（sFlt-1）水平与不良孕产妇结局之间的关联，这些孕妇患有或未患有妊娠高血压疾病（HDP）。
我们对确诊为SARS-CoV-2感染且需要住院治疗的孕妇进行了一项多中心回顾性队列研究。暴露队列包括诊断为HDP的女性。主要结局是不良孕产妇结局的综合定义。使用弹性网回归评估预测因素与主要和次要结局之间的关联，弹性网回归包括套索回归和岭回归方法，用于自动变量选择，并使用10折交叉验证对非统计学显著系数进行惩罚，其中最佳模型由最低的赤池信息准则（AIC）和贝叶斯信息准则（BIC）自动选择。
在148例COVID-19孕妇中，最佳预测模型包括sFlt-1中位数倍数（MoMs）[比值比（OR）：5.13；95%置信区间（CI）：2.19 - 12.05]和HDP（OR：32.76；95% CI：5.24 - 205）。尽管对HDP进行了校正，但sFlt-1 MoMs与不良孕产妇结局的概率增加独立相关。
我们的研究表明，无论高血压状态如何，sFlt-1都是SARS-CoV-2感染女性不良结局的独立预测因子。
