Re: Pre‐eclampsia‐like syndrome induced by severe COVID‐19: a prospective observational study

Leavitt, AO; Li, Q; Chan, ED

doi:10.1111/1471-0528.16584

Cited by 7 publications

(6 citation statements)

References 7 publications

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“…There is no doubt that this proposal by Mendoza et al [132] has to be analysed with care. In this particular, several authors have discussed this proposal by Mendoza et al [135] , [136] , [137] . Evidently, as above-mentioned severe SARS-CoV-2 infection of pregnant women may mimic the inflammatory pattern seen in pre-eclamptic pregnant women [133] , [134] .…”

Section: Covid-19 and Eopementioning

confidence: 98%

“…Leavitt et al [136] have indicated that endothelial damage is a common feature of the pathophysiology of preeclampsia with severe features and severe infection with COVID-19, which could lead to multi-organ dysfunction. Furthermore, Leavitt et al [136] have summarized three possible links between severe COVID-19 infection and preeclampsia: 1) Neutrophil extracellular traps (NETs), which are DNA and histones released by neutrophils when destroying bacteria, play an important role in both the endothelial damage seen in COVID-19 and preeclampsia [139] . In this regard, it should be noted that endothelial damage is not unique to loPE, but is also present in eoPE [140] .…”

Section: Covid-19 and Eopementioning

confidence: 99%

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SARS- CoV-2 infection and oxidative stress in early-onset preeclampsia

Marı́n

Pujol

Rojas

et al. 2022

Biochimica et Biophysica Acta (BBA) - Molecular Basis of Diseas

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SARS-CoV-2 causes coronavirus disease 2019 (COVID-19) also in pregnant women. Infection in pregnancy leads to maternal and placental functional alterations. Pregnant women with vascular defects such as preeclampsia show high susceptibility to SARS-CoV-2 infection by undefined mechanisms. Pregnant women infected with SARS-CoV-2 show higher rates of preterm birth and caesarean delivery, and their placentas show signs of vasculopathy and inflammation. It is still unclear whether the foetus is affected by the maternal infection with this virus and whether maternal infection associates with postnatal affections. The SARS-CoV-2 infection causes oxidative stress and activation of the immune system leading to cytokine storm and next tissue damage as seen in the lung. The angiotensin-converting-enzyme 2 expression is determinant for these alterations in the lung. Since this enzyme is expressed in the human placenta, SARS-CoV-2 could infect the placenta tissue, although reported to be of low frequency compared with maternal lung tissue. Early-onset preeclampsia shows higher expression of ADAM17 (a disintegrin and metalloproteinase 17) causing an imbalanced renin-angiotensin system and endothelial dysfunction. A similar mechanism seems to potentially account for SARS-CoV-2 infection. This review highlights the potentially common characteristics of pregnant women with eoPE with those with COVID-19. A better understanding of the mechanisms of SARS-CoV-2 infection and its impact on the placenta function is determinant since eoPE/COVID-19 association may result in maternal metabolic alterations that might lead to a potential worsening of the foetal programming of diseases in the neonate, young, and adult.

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Section: Covid-19 and Eopementioning

confidence: 98%

Section: Covid-19 and Eopementioning

confidence: 99%

SARS- CoV-2 infection and oxidative stress in early-onset preeclampsia

Marı́n

Pujol

Rojas

et al. 2022

Biochimica et Biophysica Acta (BBA) - Molecular Basis of Diseas

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“…This high positivity rate has also been reported in other studies with ranges varying from 1.4 to 14.5%, depending on the community prevalence of the area [ 18 , 20 - 22 ]. On one hand, a plausible explanation is that based on the association of COVID-19 with preeclampsia [ 23 ]. On the other hand, most pregnant women with preeclampsia may have been referred to the Karolinska University hospital, where the COVID-19 diagnosis was performed, capturing more COVID-19-positive pregnant women and therefore overestimating the positivity rate found in our study.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 testing in patients with low COVID-19 suspicion at admission to a tertiary care hospital, Stockholm, Sweden, March to September 2020

et al. 2022

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Background Universal SARS-CoV-2 testing at hospital admission has been proposed to prevent nosocomial transmission. Aim To investigate SARS-CoV-2 positivity in patients tested with low clinical COVID-19 suspicion at hospital admission. Methods We characterised a retrospective cohort of patients admitted to Karolinska University Hospital tested for SARS-CoV-2 by PCR from March to September 2020, supplemented with an in-depth chart review (16 March–12 April). We compared positivity rates in patients with and without clinical COVID-19 suspicion with Spearman’s rank correlation coefficient. We used multivariable logistic regression to identify factors associated with test positivity. Results From March to September 2020, 66.9% (24,245/36,249) admitted patient episodes were tested; of those, 61.2% (14,830/24,245) showed no clinical COVID-19 suspicion, and the positivity rate was 3.2% (469/14,830). There was a strong correlation of SARS-CoV-2 positivity in patients with low vs high COVID-19 suspicion (rho = 0.92; p < 0.001). From 16 March to 12 April, the positivity rate was 3.9% (58/1,482) in individuals with low COVID-19 suspicion, and 3.1% (35/1,114) in asymptomatic patients. Rates were higher in women (5.0%; 45/893) vs men (2.0%; 12/589; p = 0.003), but not significantly different if pregnant women were excluded (3.7% (21/566) vs 2.2% (12/589); p = 0.09). Factors associated with SARS-CoV-2 positivity were testing of pregnant women before delivery (odds ratio (OR): 2.6; 95% confidence interval (CI): 1.3–5.4) and isolated symptoms in adults (OR: 3.3; 95% CI: 1.8–6.3). Conclusions This study shows a relatively high SARS-CoV-2 positivity rate in patients with low COVID-19 suspicion upon hospital admission. Universal SARS-CoV-2 testing of pregnant women before delivery should be considered.

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“…In the context of endothelial damage, three common players have been proposed in PE and severe COVID-19 pathophysiological mechanisms: NETosis, anti-phospholipid antibodies (aPLAs) and α-1-antitrypsin ( 182 ). However, only the first two aspects concern an engagement of C.…”

Section: Pre-eclampsia In Covid-19 and The Role Of Complement Systemmentioning

confidence: 99%

COVID-19, Pre-Eclampsia, and Complement System

et al. 2021

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COVID-19 is characterized by virus-induced injury leading to multi-organ failure, together with inflammatory reaction, endothelial cell (EC) injury, and prothrombotic coagulopathy with thrombotic events. Complement system (C) via its cross-talk with the contact and coagulation systems contributes significantly to the severity and pathological consequences due to SARS-CoV-2 infection. These immunopathological mechanisms overlap in COVID-19 and pre-eclampsia (PE). Thus, mothers contracting SARS-CoV-2 infection during pregnancy are more vulnerable to developing PE. SARS-CoV-2 infection of ECs, via its receptor ACE2 and co-receptor TMPRSS2, can provoke endothelial dysfunction and disruption of vascular integrity, causing hyperinflammation and hypercoagulability. This is aggravated by bradykinin increase due to inhibition of ACE2 activity by the virus. C is important for the progression of normal pregnancy, and its dysregulation can impact in the form of PE-like syndrome as a consequence of SARS-CoV-2 infection. Thus, there is also an overlap between treatment regimens of COVID-19 and PE. C inhibitors, especially those targeting C3 or MASP-2, are exciting options for treating COVID-19 and consequent PE. In this review, we examine the role of C, contact and coagulation systems as well as endothelial hyperactivation with respect to SARS-CoV-2 infection during pregnancy and likely development of PE.

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Re: Pre‐eclampsia‐like syndrome induced by severe COVID‐19: a prospective observational study

Abstract: Currie et al. 1 that this topic is not fully explored and support the suggestion that lower urinary tract symptoms, urine microscopy and culture data should be included in future studies.

Cited by 7 publications

References 7 publications

SARS- CoV-2 infection and oxidative stress in early-onset preeclampsia

SARS- CoV-2 infection and oxidative stress in early-onset preeclampsia

SARS-CoV-2 testing in patients with low COVID-19 suspicion at admission to a tertiary care hospital, Stockholm, Sweden, March to September 2020

COVID-19, Pre-Eclampsia, and Complement System

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