Associação entre níveis de citocinas, índices derivados do hemograma e escores de risco cardiovascular em mulheres com histórico de pré-eclâmpsia (Estudo PERLA-BRASIL)

Abstract

Preeclampsia (PE) is a multifactorial gestational syndrome characterized by hypertension, endothelial dysfunction, and systemic inflammation, affecting 3–5% of pregnancies. Associated with an increased risk of long-term cardiovascular disease (CVD) and metabolic complications, PE is closely linked to inflammation, marked by an imbalance between pro- and anti-inflammatory cytokines that play a central role in its pathogenesis and cardiovascular consequences. This ambispective cohort study assessed plasma cytokine levels, hematological indices derived from complete blood count, and cardiovascular risk (CVR) scores in women with a history of PE (n = 103) compared with normotensive pregnancy controls (n = 102). The biomarkers analyzed included interleukins (IL-6, IL-10, IL-4), tumor necrosis factor (TNF), and transforming growth factor beta (TGF-β), as well as hematological indices such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). Women with a history of PE showed significantly higher plasma levels of IL-6 (38.69 pg/mL vs. 36.08 pg/mL, p = 0.0331) and TGF-β (11.92 pg/mL vs. 7.63 pg/mL, p < 0.0001) compared with controls. This inflammatory profile was associated with higher Framingham CVR scores at 10 years, reinforcing the link between PE and increased long-term cardiovascular risk. These findings highlight the need for ongoing clinical follow-up in women with prior PE. Monitoring inflammatory and hematological biomarkers, combined with risk stratification and early intervention, is crucial to reducing cardiovascular morbidity and mortality. Future research should investigate additional biomarkers to refine postpartum risk assessment. In conclusion, PE is a significant risk factor for CVD and metabolic complications, requiring a multidisciplinary approach. Integrating biomarkers and hematological indices into clinical practice may enable personalized interventions, improving maternal health and mitigating long-term cardiovascular impact.