{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T14:28:45Z","timestamp":1761920925928,"version":"build-2065373602"},"reference-count":34,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T00:00:00Z","timestamp":1632355200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Background: In healthy pregnancies, components of the Renin-Angiotensin system (RAS) are present in the placental villi and contribute to invasion, migration, and angiogenesis. At the same time, soluble fms-like tyrosine kinase 1 (sFlt-1) production is induced after binding of ANG-II to its receptor (AT-1R) in response to hypoxia. As RAS plays an essential role in the pathogenesis of COVID-19, we hypothesized that angiogenic marker (sFlt-1) and RAS components (ANG-II and ACE-2) may be related to adverse outcomes in pregnant women with COVID-19; Methods: Prospective cohort study. Primary outcome was severe pneumonia. Secondary outcomes were ICU admission, intubation, sepsis, and death. Spearman\u2019s Rho test was used to analyze the correlation between sFlt-1 and ANG-II levels. The sFlt-1\/ANG-II ratio was determined and the association with each adverse outcome was explored by logistic regression analysis and the prediction was assessed using receiver-operating-curve (ROC); Results: Among 80 pregnant women with COVID-19, the sFlt-1\/ANG-II ratio was associated with an increased probability of severe pneumonia (odds ratio [OR]: 1.31; p = 0.003), ICU admission (OR: 1.05; p = 0.007); intubation (OR: 1.09; p = 0.008); sepsis (OR: 1.04; p = 0.008); and death (OR: 1.04; p = 0.018); Conclusion: sFlt-1\/ANG-II ratio is a good predictor of adverse events such as pneumonia, ICU admission, intubation, sepsis, and death in pregnant women with COVID-19.<\/jats:p>","DOI":"10.3390\/v13101906","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T23:08:31Z","timestamp":1632784111000},"page":"1906","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Novel Ratio Soluble Fms-like Tyrosine Kinase-1\/Angiotensin-II (sFlt-1\/ANG-II) in Pregnant Women Is Associated with Critical Illness in COVID-19"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7276-8463","authenticated-orcid":false,"given":"Salvador","family":"Espino-y-Sosa","sequence":"first","affiliation":[{"name":"Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico"},{"name":"Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City 06720, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4711-3857","authenticated-orcid":false,"given":"Raigam Jafet","family":"Martinez-Portilla","sequence":"additional","affiliation":[{"name":"Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico"},{"name":"Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City 06720, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9524-4133","authenticated-orcid":false,"given":"Johnatan","family":"Torres-Torres","sequence":"additional","affiliation":[{"name":"Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico"},{"name":"Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City 06720, Mexico"},{"name":"Maternal Fetal Medicine Department, Hospital General de Mexico, \u201cDr. Eduardo Liceaga\u201d, Mexico City 06720, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4529-8296","authenticated-orcid":false,"given":"Juan Mario","family":"Solis-Paredes","sequence":"additional","affiliation":[{"name":"Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9551-9021","authenticated-orcid":false,"given":"Guadalupe","family":"Estrada-Gutierrez","sequence":"additional","affiliation":[{"name":"Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Antonio","family":"Hernandez-Pacheco","sequence":"additional","affiliation":[{"name":"Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9087-8017","authenticated-orcid":false,"given":"Aurora","family":"Espejel-Nu\u00f1ez","sequence":"additional","affiliation":[{"name":"Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5677-5572","authenticated-orcid":false,"given":"Paloma","family":"Mateu-Rogell","sequence":"additional","affiliation":[{"name":"Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico"},{"name":"Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City 06720, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7943-946X","authenticated-orcid":false,"given":"Angeles","family":"Juarez-Reyes","sequence":"additional","affiliation":[{"name":"Maternal Fetal Medicine Department, Hospital General de Mexico, \u201cDr. Eduardo Liceaga\u201d, Mexico City 06720, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6459-4501","authenticated-orcid":false,"given":"Francisco Eduardo","family":"Lopez-Ceh","sequence":"additional","affiliation":[{"name":"Maternal Fetal Medicine Department, Hospital General de Mexico, \u201cDr. Eduardo Liceaga\u201d, Mexico City 06720, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6135-4270","authenticated-orcid":false,"given":"Jose Rafael","family":"Villafan-Bernal","sequence":"additional","affiliation":[{"name":"Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City 06720, Mexico"},{"name":"Laboratory of Immunogenomics and Metabolic Diseases, Instituto Nacional de Medicina Genomica, Mexico City 14610, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lourdes","family":"Rojas-Zepeda","sequence":"additional","affiliation":[{"name":"Maternal Fetal Medicine Department, Instituto Materno Infantil del Estado de Mexico, Mexico City 50170, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1535-4226","authenticated-orcid":false,"given":"Iris Paola","family":"Guzman-Guzman","sequence":"additional","affiliation":[{"name":"Faculty of Chemical-Biological Sciences, Autonomous University of Guerrero, Chilpancingo 39086, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liona C.","family":"Poon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1002\/uog.23575","article-title":"Pregnant women with SARS-CoV-2 infection are at higher risk of death and pneumonia: Propensity score matched analysis of a nationwide prospective cohort 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