Case Control Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2023; 11(17): 3993-4002
Published online Jun 16, 2023. doi: 10.12998/wjcc.v11.i17.3993
Elabela is a reliable biomarker for predicting early onset preeclampsia: A comparative study
Eham Amer Ali, Wassan Nori, Alea Farhan Salman, Taghreed S Saeed Al-Rawi, Ban H Hameed, Raid M Al-Ani
Eham Amer Ali, Department of Chemistry and Biochemistry, Mustansiriyah University, Baghdad 10052, Iraq
Wassan Nori, Ban H Hameed, Department of Obstetrics and Gynecology, Mustansiriyah University, Baghdad 10052, Iraq
Alea Farhan Salman, National Central of Hematology, Mustansiriyah University, Baghdad 10052, Iraq
Taghreed S Saeed Al-Rawi, Department of Biochemistry, University of Anbar College of Medicine, Ramadi City 31001, Anbar, Iraq
Raid M Al-Ani, Department of Surgery/Otolaryngology, University of Anbar College of Medicine, University of Anbar College of Medicine, Ramadi City 31001, Anbar, Iraq
Author contributions: Ali EA and Nori W designed research and reviewed data, wrote and revised the manuscript; Salman AF and Hameed BH collected and analyzed the data; Al-Rawi TSS and Al-Ani RM did the literature review; Al-Ani RM was responsible for the final revision and drafting of the manuscript; and all the authors have read and agreed on the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Scientific-Ethical Committee of the Mustansiriyah University (Approval No. IRB126).
Informed consent statement: All pregnant gave written consent prior to enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets analyzed during the current study are available in the hospital’s “sheet patient records” and from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raid M Al-Ani, MBChB, N/A, Academic Editor, Consultant Physician-Scientist, Full Professor, Researcher, Science Editor, Department of Surgery/Otolaryngology, University of Anbar College of Medicine, University of Anbar College of Medicine, Al-Andalus, No. 41 Street, Ramadi City 31001, Anbar, Iraq. med.raed.alani2003@uoanbar.edu.iq
Received: March 18, 2023
Peer-review started: March 18, 2023
First decision: May 9, 2023
Revised: May 9, 2023
Accepted: May 15, 2023
Article in press: May 15, 2023
Published online: June 16, 2023
ARTICLE HIGHLIGHTS
Research background

Preeclampsia (PE) is a multisystemic disease that can cause problems for both the mother and the baby. It can start early or late, depending on how far along the pregnancy is. Elabela (Ela) is a recently found peptide hormone that was linked to the development of PE. Since the only safe way to treat PE is to end a pregnancy, the goal of this study was to see if plasma Ela could be used as a reliable way to predict PE based on the time of onset.

Research motivation

Endogenous ligand for apelin (APJ) receptors is found in many different parts of the human body, and Ela is produced by the fetus and placenta during pregnancy. Ela has a number of roles in embryonic life. During embryonic life, it stops renal remodeling, angiogenesis, and vascular morphogenesis. Also, the Ela-APJ system is very important for the development of the heart and blood vessels in a fetus. It can lower the tone of the blood vessels by directly relaxing the blood vessels in the aorta. This lowers blood pressure.

Research objectives

To determine the reliability of Ela in predicting PE based on time of incidence early (EoPE) vs late (LoPE) in order to reduce PE-related morbidity.

Research methods

In a case-control study, pregnant women were divided into three groups: EoPE (30/90) (< 34 wk of gestation), LoPE (30/90) (≥ 34 wk of gestation), and healthy pregnant (30/90). Demographic criteria were examined, as well as biochemical, hematological, and maternal plasma Ela levels.

Research results

Serum Ela was significantly reduced in EoPE compared to LoPE and healthy controls (P = 0.0023); Ela had a strong inverse relationship to mean atrial blood pressure (r = -0.7, P < 0.001), and a moderate correlation with gestational age and platelets count (r = 0.4, P < 0.0001. The predictive ability of 25 centile serum Ela had an odds ratio of 5.21, 95% confidence interval (1.28, 21.24), P = 0.02 for predicting EoPE. Ela’s cutoff value (> 9.15) distinguished EoPE with 96.7% sensitivity, 93.3% specificity, and P < 0.0001.

Research conclusions

Ela is a highly recommended marker in screening due to its high sensitivity and specificity in differentiating EoPE from other conditions such as body mass index, age, and blood pressure.

Research perspectives

Ela’s specificity and sensitivity, independent of gestational age, body mass index, and mean arterial pressure, lend credence to Ela’s ability to predict. As an added bonus, the therapeutic use proposed by previous researchers may eventually reveal prognostic application for lowering CVS risk in postpartum women. Further study is required to verify its usefulness in clinical settings.