Avaliação de células endoteliais circulantes como possíveis marcadores de diagnóstico na pré-eclâmpsia: uma revisão sistemática

Abstract

Preeclampsia (PE) is a multifactorial and multisystemic disease, whose pathophysiology involves endothelial injury, increased number of Circulating Endothelial Cells (CECs) and activation of coagulation. It has as diagnostic criteria hypertension, which occurs after 20 weeks of gestation, accompanied by proteinuria and/or target organ dysfunction. PE is associated with several complications both maternal and fetal, which may culminate in death. Thus, the identification of biomarkers with diagnostic power can lead to early interventions, minimizing complications. Some studies have evaluated the association of the number of CECs with the development of PE. Thus, the aim of this study was to investigate whether these cells can be used in the diagnosis of PE. For this, a systematic review was prepared according to PRISMA guidelines and registered in PROSPERO (CRD42021226265). PubMed; Lilacs; Scopus; Embase; Web of Science; Science Direct; Cochrane Library and Gray-literature: CAPES and Google Scholar, were the databases used to search for articles published until July 2022, without language restriction. The clinical question was elaborated according to the PECOT strategy, being eligible observational studies (cross-sectional, case-control and cohort), which evaluated the CECs count in peripheral blood of pregnant women diagnosed with PE and normotensive women, and the main outcome was the difference in CECs count between these patients. The selection by title and abstract, full-text reading, and data extraction steps were performed by two researchers independently and a third for conflict decision. In total, 505 articles were retrieved by the search strategy and 6 articles met the inclusion criteria. The methodological quality of the selected studies was assessed using the Newcastle-Ottawa scale, and all had a low risk of bias. There was a statistically significant increase in the CECs count in most studies when comparing the PE and control groups. Only one study showed that there was no significant difference. Furthermore, the studies also found a positive correlation between increased blood pressure and CECs counts. Thus, the CECs count has great potential to be used as a new diagnostic biomarker for PE.