Prediction of organ complications in women with a confirmed diagnosis of preeclampsia by glycocalyx degradation products.

OBJECTIVES

Elevated plasma concentrations of glycocalyx degradation products have been associated with organ dysfunction in preeclampsia. We hypothesized that the glycocalyx degradation products syndecan-1, hyaluronic acid, and thrombomodulin, could predict subsequent organ dysfunction in women diagnosed with preeclampsia.

STUDY

DESIGN

This was a prospective, observational cohort study.

MAIN OUTCOME MEASURES: Women were enrolled at the time of diagnosis, provided no organ dysfunction was present. The primary outcome was a composite of complications based on the core outcome set for preeclampsia research (BJOG 2020). Exposures were plasma concentrations of syndecan-1, hyaluronic acid and thrombomodulin. Receiver operating characteristic curves were constructed for the composite and for single outcomes with ≥ 10 events. Predictive performance was quantified as the area under the curve (AUC) with a 95% confidence interval (CI).

RESULTS

None of the glycocalyx degradation products predicted the composite outcome. For single outcomes, syndecan-1 was associated with elevated liver enzymes (AUC of 0.64; 95% CI 0.52-0.76). Hyaluronic acid predicted thrombocytopenia (AUC 0.67; 95% CI 0.52-0.83) and elevated liver enzymes (AUC 0.69; 95% CI 0.57-0.82). Combining the markers in multivariable analyses showed similar results as univariable analyses. When combined with sFlt-1, none of the glycocalyx degradation products improved the predictive performance compared to sFlt-1 alone.

CONCLUSION

In women with a confirmed diagnosis of preeclampsia, plasma concentrations of syndecan-1, hyaluronic acid, and thrombomodulin demonstrated limited predictive ability for the subsequent composite outcome of organ dysfunction. Hyaluronic acid was the most promising marker for the single outcomes thrombocytopenia and elevated liver enzymes.