The sFlt-1/PlGF ratio and its predictive value concerning time to delivery in patients with preeclampsia – preliminary data

The sFlt-1/PlGF ratio has high sensitivity and specificity to diagnose preeclampsia (PE) and to predict pregnancy outcome. Especially in patients with preexisting hypertension and/or proteinuria, diagnosis and management of PE is challenging. We studied the predictive value of the sFlt-1/PlGF ratio for the occurrence of adverse outcome in patients with a high prevalence of preexisting hypertension or proteinuria, clinically suspected of having PE. A sFlt-1/PlGF ratio >= 85 was considered to be a positive test. Adverse pregnancy outcome was defined as HELPP syndrome, intra-uterine growth restriction, or perinatal death. The predictive value of adverse pregnancy outcome of preeclampsia based on clinical grounds (clinical PE) or of a positive ratio was compared using a logistic regression model corrected for gestational age at testing. Results: So far 64 patients with a gestational age (GA) of 29.3 wks (range 20-37 wks) were included. 19 had preexisting hypertension, 5 had preexisting proteinuria and 6 had both conditions. At time of measurement 23 patients had clinical PE (4 with a negative ratio) and 30 patients had a positive sFlt-1/PlGF test (11 without clinical PE at testing of whom 7 developed clinical PE within 2 wks). 27% of patients had an adverse outcome of pregnancy. GA between patients with clinical PE or a positive test did not differ. Patients with clinical PE at the time of testing had an odds ratio of 2.5 (95% CI: 0.75 - 7.8) and patients with a positive test had an odds ratio of 6.8 (95% CI;2.1 - 33.9) for an adverse outcome. Patients with clinical PE had an absolute risk for an adverse outcome of 39% (9/23) compared to 46%(14/30) for patients with a positive sFlt-1/PlGF test (p=.075) In patients where the diagnosis of PE is challenging because of preexisting hypertension and/or proteinuria a positive sFlt-1/PlGF is a stronger determinant for poor pregnancy outcome than the clinical diagnosis of PE. An explanation could be that a positive ratio can select patients that will develop PE in the near future and because of misclassification of patients with preexisting hypertension and/or proteinuria.

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A more accurate prediction to rule in and rule out pre-eclampsia using the sFlt-1/PlGF ratio and NT-proBNP as biomarkers

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2019-0939 ◽

2020 ◽

Vol 58 (3) ◽

pp. 399-407

Author(s):

Paula Lafuente-Ganuza ◽

Paloma Lequerica-Fernandez ◽

Francisco Carretero ◽

Ana I. Escudero ◽

Eduardo Martinez-Morillo ◽

...

Keyword(s):

Predictive Value ◽

Early Onset ◽

Retrospective Cohort ◽

Validation Cohort ◽

Placental Growth Factor ◽

Machine Learning Model ◽

Positive Results ◽

Plgf Ratio ◽

Rule Out ◽

Singleton Pregnancies

AbstractBackgroundThe management of potential pre-eclamptic patients using the soluble FMS-like tyrosine kinase 1 (sFlt-1)/ placental growth factor (PlGF) ratio is characterised by frequent false-positive results.MethodsA retrospective cohort study was conducted to identify and validate cut-off values, obtained using a machine learning model, for the sFlt-1/PlGF ratio and NT-proBNP that would be predictive of the absence or presence of early-onset pre-eclampsia (PE) in singleton pregnancies presenting at 24 to 33 + 6 weeks of gestation.ResultsFor the development cohort, we defined two sFlt-1/PlGF ratio cut-off values of 23 and 45 to rule out and rule in early-onset PE at any time between 24 and 33 + 6 weeks of gestation. Using an sFlt-1/PlGF ratio cut-off value of 23, the negative predictive value (NPV) for the development of early-onset PE was 100% (95% confidence interval [CI]: 99.5–100). The positive predictive value (PPV) of an sFlt-1/PlGF ratio >45 for a diagnosis of early-onset PE was 49.5% (95% CI: 45.8–55.6). When an NT-proBNP value >174 was combined with an sFlt-1/PlGF ratio >45, the PPV was 86% (95% CI: 79.2–92.6). In the validation cohort, the negative and positive values were very similar to those found for the development cohort.ConclusionsAn sFlt-1/PlGF ratio <23 rules out early-onset PE between 24 and 33 + 6 weeks of gestation at any time, with an NPV of 100%. An sFlt-1/PlGF ratio >45 with an NT-proBNP value >174 significantly enhances the probability of developing early-onset PE.

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P28. Predictive value of the sFlt-1/PlGF ratio in pregnancies at risk for hypertensive disorders

Pregnancy Hypertension ◽

10.1016/j.preghy.2011.08.089 ◽

2011 ◽

Vol 1 (3-4) ◽

pp. 285-286 ◽

Cited By ~ 1

Author(s):

S. Husse ◽

W. Schaarschmidt ◽

A. Jank ◽

B. Denk ◽

H. Stepan

Keyword(s):

At Risk ◽

Predictive Value ◽

Hypertensive Disorders ◽

Plgf Ratio

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The predictive value of sFlt-1/PIGF ratio in high risk patients for the development of preeclampsia

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193802 ◽

2019 ◽

Vol 8 (9) ◽

pp. 3705

Author(s):

Isha Sunil ◽

Mitali Sharma

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Maternal Morbidity ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Maternal Morbidity And Mortality ◽

Risk Patients ◽

The Mean ◽

Plgf Ratio

Background: Hypertensive disorders of pregnancy constitute a major cause of maternal morbidity and mortality. Pre-eclampsia/eclampsia ranks second only to haemorrhage as a specific, direct cause of maternal mortality. A number of markers have been under study for the early detection of this disease. The study aims to evaluate the predictive value of sFlt-1/PlGF ratio for preeclampsia.Methods: This study was conducted in the Department of Gynaecology and Obstetrics of ASCOMS hospital, Jammu for a period of 6 months from Jan 2019 to June 2019. 50 antenatal patients attending the outpatient department with risk factors for developing preeclampsia were enrolled in the study. Their sFlT-1/PIGF ratio was determined at gestational age of 20 weeks to 37 weeks and its predictive value was evaluated.Results: In the present study, 8 patients developed preeclampsia subsequently. The mean sFlt-1/PIGF ratio values were significantly higher in the patients who developed preeclampsia (73.5) than who did not develop the disease (26.07). The positive predictive value at 1 week was 41.66% and negative predictive value was 100%. At 4 weeks, positive predictive value was 66.66% and negative predictive value was 100%.Conclusions: The present study suggests sFlt-1/PIGF ratio values are useful marker was a predictor of preeclampsia and values >38 were associated with preeclampsia. It is more useful in ruling out preeclampsia than ruling in the disease.

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Prognostic Value of Angiogenic Markers in Pregnant Women With Chronic Hypertension

Journal of the American Heart Association ◽

10.1161/jaha.120.020631 ◽

2021 ◽

Author(s):

Julia Binder ◽

Pilar Palmrich ◽

Erkan Kalafat ◽

Petra Pateisky ◽

Ebru Öztürk ◽

...

Keyword(s):

Retrospective Study ◽

Growth Factor ◽

Prognostic Value ◽

Placental Growth Factor ◽

Chronic Hypertension ◽

Increased Risk ◽

Angiogenic Markers ◽

Time To Delivery ◽

Plgf Ratio ◽

Angiogenic Marker

Background Women with chronic hypertension face a 5‐ to 6‐fold increased risk of developing preeclampsia compared with normotensive women. Angiogenic markers, especially soluble fms‐like kinase 1 (sFlt‐1) and placental growth factor (PlGF), were identified as clinically useful markers predicting the development of preeclampsia, but data on the prediction of superimposed preeclampsia are scarce. Therefore, we aimed to evaluate the predictive value of the sFlt‐1/PlGF ratio for delivery because of superimposed preeclampsia in women with chronic hypertension. Methods and Results This retrospective study included 142 women with chronic hypertension and suspected superimposed preeclampsia. Twenty‐seven women (19.0%) delivered because of maternal indications only, 17 women (12.0%) because of fetal indications primarily, and 98 women (69.0%) for other reasons. Women who both delivered because of maternal indications and for fetal indications had a significantly higher sFlt‐1/PlGF ratio (median 99.9 and 120.2 versus 7.3, respectively, P <0.001 for both) and lower PlGF levels (median 73.6 and 53.3 versus 320.0 pg/mL, respectively, P <0.001 for both) compared with women who delivered for other reasons. SFlt‐1/PlGF ratio and PlGF were strong predictors for delivery because of superimposed preeclampsia, whether for maternal or fetal indications ( P <0.05). Half of women with angiogenic imbalance (sFlt‐1/PlGF ratio ≥85 or PlGF levels <100 pg/mL) delivered because of maternal or fetal indications within 1.6 weeks (95% CI, 1.0–2.4 weeks). Conclusions Angiogenic marker imbalance in women with suspected superimposed preeclampsia can predict delivery because of maternal and fetal indications related to superimposed preeclampsia and is associated with a significantly shorter time to delivery interval.

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