Endothelial Activation and Stress Index in Different Types of Hypertensive Pregnancy Disorders

Endothelial dysfunction is a major contributor to the pathophysiology of preeclampsia and can be quantified by the simple formula, lactate dehydrogenase×creatinine/thrombocytes, termed the Endothelial Activation and Stress Index (EASIX). We evaluated EASIX in hypertensive disorders of pregnancy and its value in the assessment of preeclampsia.

This retrospective study included 465 patients with preeclampsia, 197 with chronic or gestational hypertension, and 894 controls who delivered at Heidelberg University Hospital between 2017 and 2022. Propensity score matching was used to balance confounding variables. A total of 3732 EASIX values were available for the analysis.

The mean age was 31.8±5.6 years (preeclampsia), 32.9±5.3 years (hypertension), and 31.7±5.8 years (controls). EASIX was significantly higher in patients with preeclampsia as compared with patients with hypertension (0.94±0.58 versus 0.60±0.28, P<0.001) and with controls (0.94±0.58 versus 0.55±0.23, P<0.001). The diagnostic accuracy of EASIX for a diagnosis of preeclampsia yielded an area under the curve of 0.76 (0.73-0.79, P<0.001). A high number of end-organ manifestations in patients with preeclampsia was associated with higher EASIX. Analyses of EASIX trajectories across gestation showed an increase of +30.8% in normotensive patients, whereas EASIX levels did not differ in preeclampsia before versus after 34 weeks (0.94±0.60 versus 0.95±0.57, P=0.65).

EASIX is a simple marker that could potentially discriminate patients with preeclampsia from healthy controls. We propose that EASIX may serve as a promising additional biomarker in the assessment of preeclampsia, prompting us to explore its incorporation in potential combined biomarker models in clinical routine.