Zúñiga RA, Montelongo FJ, Suárez SA, Galindo AJ, Herrera MBE, Calderón MNM

Language: Spanish
References: 11
Page: 664-668
PDF size: 262.67 Kb.

ABSTRACT

Introduction: preeclampsia is a syndrome that presents after the 20th week of gestation and is characterized by arterial hypertension and proteinuria, or hypertension with organ dysfunction. Symptoms include visual disturbances, headache, abdominal pain, thrombocytopenia and liver dysfunction, resulting from microangiopathy in organs such as the brain, liver, kidneys and placenta. Widespread endothelial dysfunction causes these signs and in the neurological setting, hyperreflexia may indicate neuronal damage in the cerebral cortex due to cytotoxic edema, which can lead to clonus and seizures. The "Las Americas General Hospital and Intensive Care Scale" helps to assess deep osteotendinous reflexes in these patients. During pregnancy, placentation requires angiogenesis for an adequate vascular network. An imbalance between proangiogenic factors (such as VEGF and PlGF) and antiangiogenic factors (such as sFlt-1) can cause endothelial dysfunction and preeclampsia. Although these biomarkers are useful in predicting disease, their relationship with neurological manifestations such as hyperreflexia in severe preeclampsia or eclampsia has not been studied. Objective: to determine whether there is association with the presence of hyperreflexia and its degrees with levels of sFlt-1, PlGF and sFlt-1/PlGF ratio in preeclampsia with severity criteria and eclampsia. Material and methods: a prospective and analytical study was performed in the intensive care unit of Hospital General "Las Americas" which was carried out from August 31, 2023 to April 5, 2024, included the measurement of serum levels of sFlt-1 and PlGF, and the evaluation of osteotendinous reflexes using a validated scale. Blood samples were processed in a central laboratory and results were obtained in approximately 48 hours. Data were analyzed with SPSS using medians and statistical tests, such as Kruskal-Wallis, to determine the relationship between biomarkers and hyperreflexia. Results: ninety-six patients were included, of whom 63 had preeclampsia with severity criteria; all received magnesium sulfate treatment. 88.5% showed elevated sFlt-1 levels and 84.2% had increased or severe hyperreflexia. The median sFlt-1 in patients with severe hyperreflexia was 2186 pg/ml, indicating a positive relationship between sFlt-1 and hyperreflexia. Although the cutoff value for the sFlt-1/PlGF ratio varied with gestational weeks, no significance was found in the values measured in the study. The Kruskal-Wallis test showed a significant difference (p = 0.018) between sFlt-1 levels and degree of hyperreflexia, confirming that higher sFlt-1 levels are associated with higher degree of hyperreflexia. Conclusions: hyperreflexia in preeclampsia is associated with endothelial dysfunction, cerebral perfusion problems, and high sFlt-1 levels. Knowing this relationship may help to improve the evaluation and management of preeclampsia, making osteotendinous reflex scanning a useful tool at any level of medical care.

REFERENCES

1. Redman CW, Sacks GP, Sargent IL. Preeclampsia: an excessive maternal inflammatory response to pregnancy. Am J Obstet Gynecol. 1999;180(2 Pt 1):499-506.

2. Roberts JM, Taylor RN, Goldfien A. Clinical and biochemical evidence of endothelial cell dysfunction in the pregnancy syndrome preeclampsia. Am J Hypertens. 1991;4(8):700-708.

3. Kim MY, Buyon JP, Guerra MM, Rana S, Zhang D, Laskin CA, et al. Angiogenic factor imbalance early in pregnancy predicts adverse outcomes in patients with lupus and antiphospholipid antibodies: results of the PROMISSE study. Am J Obstet Gynecol. 2016;214(1):108.e1-108.e14.

4. Rana S, Powe CE, Salahuddin S, Verlohren S, Perschel FH, Levine RJ, et al. Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia. Circulation. 2012;125(7):911-919.

5. Moore AG, Young H, Keller JM, Ojo LR, Yan J, Simas TA, et al. Angiogenic biomarkers for prediction of maternal and neonatal complications in suspected preeclampsia. J Matern Fetal Neonatal Med. 2012;25(12):2651-2657.

6. Chaiworapongsa T, Romero R, Korzeniewski SJ, Cortez JM, Pappas A, Tarca AL, et al. Plasma concentrations of angiogenic/anti-angiogenic factors have prognostic value in women presenting with suspected preeclampsia to the obstetrical triage area: a prospective study. J Matern Fetal Neonatal Med. 2014;27(2):132-144.

7. March MI, Geahchan C, Wenger J, Raghuraman N, Berg A, Haddow H, Mckeon BA, et al. Circulating angiogenic factors and the risk of adverse outcomes among haitian women with preeclampsia. PLoS One. 2015;10(5):e0126815.

8. Rana S, Salahuddin S, Mueller A, Berg AH, Thadhani RI, Karumanchi SA. Angiogenic biomarkers in triage and risk for preeclampsia with severe features. Pregnancy Hypertens. 2018;13:100-106.

9. Salahuddin S, Wenger JB, Zhang D, Thadhani R, Karumanchi SA, Rana S. KRYPTOR-automated angiogenic factor assays and risk of preeclampsia-related adverse outcomes. Hypertens Pregnancy. 2016;35(3):330-345.

10. Sierra UA. Terapéutica en medicina crítica (Cap 27 Montelongo FJ). McGraw Hill/UNAM, ISBN 978-607-30-2441-9. 2020, p. 366-375.

11. Montelongo FJ, Canedo NAC. Regresando a nuestras bases clínicas de formación académica para salvar vidas: la exploración de los reflejos osteotendinosos para abatir la muerte materna por preeclampsia en México. Certeza CONACEM. 2022; 3-4: 29-31.