Increased levels of soluble fms-like tyrosine kinase-1 are associated with adverse outcomes in pregnant women with COVID-19.

Torres-Torres, J; Espino-Y-Sosa, S; Poon, L C; Solis-Paredes, J M; Estrada-Gutierrez, G; Espejel-Nuñez, A; Juarez-Reyes, A; Etchegaray-Solana, A; Alfonso-Guillen, Y; Aguilar-Andrade, L; Hernández-Pacheco, J A; Villafan-Bernal, J R; Martinez-Portilla, R J

Besides the lungs, the placenta and the endothelium are organs affected by SARS-CoV-2. Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are markers of endothelial dysfunction and could potentially serve as predictors of severe COVID-19. We aimed to investigate the association between serum concentrations of sFlt-1 and PlGF with the severity of COVID-19 in pregnancy. We performed a prospective cohort carried out in a tertiary hospital in Mexico City. We included all symptomatic pregnant women with a positive RT-qPCR test for SARS-CoV-2 infection. The primary outcome was severe pneumonia due to COVID-19; secondary outcomes were intensive care unit (ICU) admission, viral sepsis, and death. sFlt-1 levels were expressed as multiples of the median (MoM). The association between sFlt-1 and each adverse outcome was explored by a logistic regression analysis and the prediction was assessed using a receiver-operating-curve (ROC). Among 113 pregnant women with COVID-19, higher sFlt-1 MoM levels were associated with an increased probability of severe pneumonia in women with COVID-19 (odds ratio [OR]: 1.817; 95% CI: 1.365-2.418), ICU admission (OR: 2.195; 95% CI: 1.582-3.047), viral sepsis (OR: 2.318; 95% CI: 1.407-3.820), and maternal death (OR: 5.504; 95% CI: 1.079-28.076). At a 5% false-positive-rate, sFlt-1 showed a 38.7%, 55.6%, 66.7%, and 80% detection rate for severe COVID-19 pneumonia, ICU admission, viral sepsis, and death, respectively. sFlt-1 MoMs are higher among pregnant women with severe COVID-19 and has the capability to predict serious adverse events such as severe pneumonia, ICU admission, viral sepsis, and death This article is protected by copyright. All rights reserved.