176 - Association of endothelin -1 and cytokine levels with hyperfibrinolysis of pregnant women with preeclampsia and the deficits in fibrinogen and extrinsic pathway factors of their neonates

Publication Number: 2170.176

Georgios Christos Kontovazainitis, "Alexandra" Maternity Hospital, Athens, Athens, Attiki, Greece; Georgios Mitsiakos, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Thessaloniki, Greece; Dimitra Gialamprinou, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Thessaloniki, Greece; Alexandra Fleva, "Papageorgiou" Hospital Thessaloniki, Thessaloniki, Thessaloniki, Greece; Theodoros Theodoridis, Aristotle University of Thessaloniki, Thessaloniki, Thessaloniki, Greece; Elissavet Diamanti, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Thessaloniki, Greece

Background: Rotational thromboelastometry (ROTEM) in pregnant women with Preeclampsia (PE) reveals a hypercoagulable profile, while neonates of PE-women presented a hypocoagulable profile compared to neonates of healthy controls.

Objective: To compare cytokine and Endothelin-1 (ET-1) levels between women with PE and healthy pregnant controls, as well as between their respective neonates, and to explore their association with ROTEM parameters.

Design/Methods: We assessed their association with hyperfibrinolysis (Clot-Formation-Time CFT-APTEMMCF-EXTEM, Maximum-Lysis ML-EXTEM>15% with normal ML-APTEM), deficit in fibrinogen (MCF-FIBTEM < 13mm), deficit in intrinsic (MCF-ΙΝΤΕΜ < 48mm) and extrinsic (MCF-ΕΧΤΕΜ < 45mm) pathway factors. Neonatal samples were drawn within the 1st hour of life.

Results: A total of 31 women with PE and 45 healthy pregnant controls, and their 34 and 47 neonates, respectively, were included in the analysis. No differences were found in maternal and neonatal baseline characteristics. PE-women presented higher Interleukin-2,6 (IL2,6) and ET1 levels, while their neonates presented higher IL2 and Tumor-Necrosis-Factor α (TNFα) levels. PE-women presented higher rates of hyperfibrinolysis compared to healthy pregnant controls (p=0.002). ET1 levels were higher in PE-women with hyperfibrinolysis compared to PE-women without hyperfibrinolysis (p < 0.001). PE-neonates presented higher rates of deficit in fibrinogen and extrinsic pathway factors compared to controls (p=0.02 and p=0.01, respectively). ET1 levels were higher in PE-neonates with fibrinogen deficit compared to PE-neonates without fibrinogen deficit (p=0.03). IL2 levels were higher in PE-neonates with extrinsic pathway factors deficit compared to PE-neonates without extrinsic pathway factors deficit (p=0.02).

Conclusion(s): Hyperfibrinolysis of PE-women is associated with higher levels of ET1. During the 1st hour of life, the ROTEM hypocoagulable profile of PE-neonates is associated with ET1 and IL2, since ET1 and IL2 were elevated in PE-neonates with deficits in fibrinogen and extrinsic pathway factors.

This table shows the results regarding neonatal hyperfibrinolysis and fibrinogen’s insufficiency (Maximum Clot Firmness -MCF- in Fibrinogen Rotational Thromboelastometry -FIBTEM- < 9 mm) in relation to cytokines and Endothelin 1 (ET1).
Table.pdf