Subphenotypes of severe early‐onset pre‐eclampsia at hospital admission. A Latin American single‐center exploratory latent class analysis

Abstract

AbstractObjectivesTo identify distinct subphenotypes of severe early‐onset pre‐eclampsia in Latin America and analyze biomarker and hemodynamic trends between subphenotypes after hospital admission.MethodsA single‐center prospective cohort study was conducted in Colombia. The latent class analysis identified subphenotypes using clinical variables, biomarkers, laboratory tests, and maternal hemodynamics. Class‐defining variables were restricted to measurements at and 24 h after admission. Primary and secondary outcomes were severe maternal and perinatal complications.ResultsAmong 49 patients, two subphenotypes were identified: Subphenotype 1 (34.7%) had a higher likelihood of an sFlt‐1/PlGF ratio ≤ 38, maternal age > 35, and low probability of TPR > 1400, CO <8, and IUGR; Subphenotype 2 (65.3%) had a low likelihood of an sFlt‐1/PlGF ratio < 38, maternal age > 35, and high probability of TPR > 1400, CO <8, and IUGR. At 24 h postadmission, 64.7% of subphenotype 1 patients changed to subphenotype 2, while 25% of subphenotype 2 patients were reclassified as subphenotype 1. Subphenotype 1 displayed significant changes in CO and TPR, while subphenotype 2 did not. Maternal complications were more prevalent in subphenotype 2, with an odds ratio of 5.3 (95% CI: 1.3–22.0; P = 0.02), but no significant differences in severe neonatal complications were observed.ConclusionsWe identified two distinct subphenotypes in a Latin American cohort of patients with severe early‐onset pre‐eclampsia. Subphenotype 2, characterized by higher TPR, sFlt‐1, and serum creatinine and lower CO and PlGF at admission, was associated with worse maternal outcomes and appeared less modifiable after in‐hospital treatment.