ENDOCAN، ASOLUBLE MARKER OF ENDOTHELIAL CELL ACTIVATION, AS AMARKER OF DISEASE SEVERITY IN WOMEN WITH PREECLAMPSIA

Background: Preeclampsia is a pregnancy-specific multisystem disorder characterized by new-onset hypertension after 20 weeks of gestation accompanied by proteinuria and/or maternal organ dysfunction, and endothelial dysfunction is considered its central pathological mechanism. Endocan (Endothelial Cell-Specific Molecule-1, ESM-1) is a soluble endothelial proteoglycan that has recently emerged as a promising biomarker of endothelial activation and vascular injury. Aim: To evaluate serum Endocan as a biomarker of endothelial cell activation in women with preeclampsia and to investigate its association with disease severity, clinical manifestations, laboratory findings, and diagnostic performance. Patients and Methods: A hospital-based case-control study was conducted at the Department of Obstetrics and Gynecology, Tikrit Teaching Hospital, Iraq, from October 2025 to June 2026 on 90 pregnant women: 45 with preeclampsia (ACOG criteria) and 45 healthy normotensive controls. Demographic, obstetric, and clinical data were collected, routine laboratory investigations were performed, and serum Endocan was measured by quantitative sandwich ELISA. ROC curve analysis and binary logistic regression were used to evaluate its diagnostic value. Results: Maternal age, gestational age, gravidity, and parity were comparable between groups (P > 0.05), whereas BMI was significantly higher in preeclampsia (P < 0.001). Women with preeclampsia had significantly higher blood pressure, white cell count, liver enzymes, creatinine, urea, and uric acid, and significantly lower platelet counts (P < 0.001). Serum Endocan was markedly higher in preeclampsia than controls (856.42±198.73 vs. 382.54±97.18 pg/mL, P < 0.001) and rose further with severity (978.81±151.63 in severe vs. 728.46±112.54 pg/mL in mild disease, P < 0.001). Endocan correlated positively with blood pressure, BMI, proteinuria, white cell count, liver enzymes, creatinine, urea, and uric acid, and negatively with platelet count. ROC analysis showed an AUC of 0.942, sensitivity 91.1%, specificity 88.9%, and accuracy 90.0%, and Endocan was the strongest independent predictor of preeclampsia on logistic regression (OR = 8.52, P < 0.001). Conclusion: Serum Endocan is significantly elevated in preeclampsia and rises further with disease severity. Its strong associations with clinical and laboratory markers of endothelial dysfunction, together with its excellent diagnostic accuracy, suggest that it is a promising biomarker for the diagnosis, severity assessment, and risk stratification of preeclampsia.