Abstract
Objectives:Endothelial disturbance and excess inflammatory response are pathogenic mechanisms in pre-eclampsia (PE). Authors determine the clinical diagnostic role for thrombomodulin (TM), plasminogen activator inhibitor-1 (PAI-1) as endothelial markers and C-reactive protein (CRP), and interlukin-6 (IL-6) as inflammatory markers when tested independently or in combinations.Materials and methods:We conducted a retrospective study in a cohort of 185 women grouped as 80 women with PE, 55 normotensive pregnant and 50 healthy non-pregnant. Plasma levels of TM, PAI-1, CRP and IL-6 were examined using enzyme linked immunosorbent assays.Results:Median levels and the positivity rates for the investigated markers were higher in PE as compared to the other groups (P< 0.0001). Using linear regression analysis, the investigated markers were significantly correlated regarding healthy nonpregnantvsPE or normotensive pregnantvsPE. The sensitivity of PAI-1 was the highest (98%) among the tested biomarkers. Combination between the investigated markers revealed absolute sensitivity (100%) and reliable specificity especially when PAI-1 was combined with CRP at 83% specificity.Conclusions:Investigated endothelial and inflammatory markers revealed sensitive diagnostic test for PE. However, coupled combination between PAI-1 with CRP showed superior both sensitivity and specificity which represent a promising new approach for detection of PE.
Highlights
Preeclampsia (PE) is a multi-system, multi-factorial disease targeted by endothelial damage which precedes the clinical diagnosis; it is estimated to affect 2%-10 of all pregnancies [1] and the fetus depending on the population studied and definitions of PE [2,3] as recent
Among these circulating endothelial markers, thrombomodulin (TM); a natural anticoagulant produced by endothelial cells and bound to their surface [7], and plasminogen
The aim for the present study is to evaluate the potential clinical utility of TM, plasminogen activator inhibitor-1 (PAI-1), C-reactive protein (CRP) and IL-6 in assessing endothelial damage and prediction of PE when tested independently or in combinations
Summary
Preeclampsia (PE) is a multi-system, multi-factorial disease targeted by endothelial damage which precedes the clinical diagnosis; it is estimated to affect 2%-10 of all pregnancies [1] and the fetus depending on the population studied and definitions of PE [2,3] as recent studies reported that PE would cluster in families, consistent with a genetic component in the pathophysiology of this disease [3,4]. The search for circulating factors mediating this generalized endothelial dysfunction has been the subject of much ongoing research. Among these circulating endothelial markers, thrombomodulin (TM); a natural anticoagulant produced by endothelial cells and bound to their surface [7], and plasminogen. Swellam et al / Detection of preeclampsia activator inhibitor-1 (PAI-1); a principle regulator of fibrinolysis [8], are known to play a role in PE
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