BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.
Increased levels of soluble fms‐like tyrosine kinase‐1 are associated with adverse outcomes in pregnant women with COVID‐19