Exploring sub-phenotypes in patients with severe pre-eclampsia: a latent class analysis

Our objective was to identify sub-phenotypes of patients with severe pre-eclampsia, including different parameters, and to assess whether the selected variables determine a more severe subgroup of pre-eclampsia. 88 were recruited between Sept. 2019 and Sept. 2021 in a descriptive cross-sectional study in Cartagena, Colombia. A latent class analysis was performed to describe different groups of patients with severe pre-eclampsia who presented changes in clinical variables (systolic and diastolic blood pressure), laboratory parameters (platelet count, creatinine and LDH), birthweight, hemodynamics (total peripheral resistance, cardiac output), oxygen delivery index and outcome (organ dysfunction and/or NICU admission). In addition, a multinomial logistic regression analysis was performed to verify which parameters identified the probability (in percentage) of each sub-phenotype, defining each one of the parameters as an independent variable and the sub-phenotypes as dependent variables. Two sub-phenotypes were identified based on the hemodynamic data, called Hyperdynamic (TPR of 1005.4 dyns/cm5 [IC95%941.2 -1069.6] and GC of 8.5 L/min (8.2-8.9)], and Hypodynamic (TPR of 1494.0 dyns/cm5 [CI95%1410.8 -1577.2)] and GC of 6.2 L/min [5.8-6.6]) (p < 0.001). The phenotypes exhibit differences in perfusion variables as iDO2 (567 mLO2/min/m2 [95%CI 524.2-610.8], vs. 728.1 mLO2/min/m2 [95%CI 691.6-764.7], lactate ≥ 2mmol/L (hypodynamic 27.7% [95%CI 15.3-44.7], vs. hyperdynamic 14.2% [95%CI 6.3-29.3]), and organ dysfunction. Two sub-phenotypes of severe pre-eclampsia were identified. A hypodynamic sub-phenotype presents a higher risk of developing adverse outcomes, including DOM, which may help identify a population of patients requiring differential management.