scholarly journals Elecsys® and Kryptor immunoassays for the measurement of sFlt-1 and PlGF to aid preeclampsia diagnosis: are they comparable?

2019 ◽  
Vol 57 (9) ◽  
pp. 1339-1348 ◽  
Author(s):  
Holger Stepan ◽  
Martin Hund ◽  
Peter Dilba ◽  
Johanna Sillman ◽  
Dietmar Schlembach
Keyword(s):  
Pregnant Women ◽  
Early Onset ◽  
Late Onset ◽  
Correlation Coefficients ◽  
Serum Samples ◽  
Elevated Liver Enzymes ◽  
Low Platelet Count ◽  
Early Onset Preeclampsia ◽  
Plgf Ratio ◽  
Control Study

Abstract Background For pregnant women with suspected preeclampsia, the soluble fms-like tyrosine-kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio is a biomarker to aid diagnosis. We performed method comparisons between Elecsys® and Kryptor sFlt-1 and PlGF immunoassays and assessed the diagnostic performance for preeclampsia. Methods Serum samples from a case-control study involving 113 pregnant women with preeclampsia/elevated liver enzymes and low platelet count (HELLP) and 270 controls were analyzed. sFlt-1 and PlGF were measured using Roche Elecsys® and BRAHMS Kryptor sFlt-1/PlGF immunoassays. The sFlt-1/PlGF ratios were calculated, and Passing-Bablok regression/Bland-Altman plots were performed. Gestation-specific cut-offs, ≤33 and ≥85/≥110, were assessed. Results Mean (±2 standard deviation [SD]) differences between the Elecsys® and Kryptor values were: sFlt-1, 173.13 pg/mL (6237.66, −5891.40); PlGF, −102.71 pg/mL (186.06, −391.48); and sFlt-1/PlGF, 151.74 (1085.11, −781.63). The Elecsys® and Kryptor immunoassays showed high correlation: Pearson’s correlation coefficients were 0.913 (sFlt-1) and 0.945 (PlGF). Slopes were 1.06 (sFlt-1) and 0.79 (PlGF), resulting in ~20% lower values for Kryptor PlGF. Sensitivities and specificities using the sFlt-1/PlGF ≥85 cut-off for early-onset preeclampsia (20 + 0 to 33 + 6 weeks) were 88.1%/100.0% (Elecsys®) and 90.5%/96.2% (Kryptor), respectively, and using the ≥110 cut-off for late-onset preeclampsia (≥34 + 0 weeks) were 51.3%/96.5% (Elecsys®) and 78.9%/90.1% (Kryptor), respectively. Using Elecsys® and Kryptor sFlt-1/PlGF, 0% and 3.8% of women, respectively, were falsely ruled-in for early-onset, and 3.5% and 9.9%, respectively, for late-onset preeclampsia. Conclusions Despite high correlation between the Elecsys® and Kryptor immunoassays, we observed significant differences between sFlt-1/PlGF and PlGF results. Therefore, sFlt-1/PlGF cut-offs validated for Elecsys® immunoassays are not transferable to Kryptor immunoassays.

Circulating Angiogenic Factors and the Risk of Preeclampsia in Systemic Lupus Erythematosus Pregnancies

2015 ◽  
Vol 42 (7) ◽  
pp. 1141-1149 ◽  
Author(s):  
Alfredo Leaños-Miranda ◽  
Inova Campos-Galicia ◽  
María Guadalupe Berumen-Lechuga ◽  
Carlos José Molina-Pérez ◽  
Yolanda García-Paleta ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Early Onset ◽  
Late Onset ◽  
Angiogenic Factors ◽  
Systemic Lupus ◽  
Serum Samples ◽  
Early Onset Preeclampsia ◽  
Nested Case Control ◽  
Plgf Ratio

Objective.To investigate whether angiogenic factors are associated with risk of developing preeclampsia in pregnant women with systemic lupus erythematosus (SLE).Methods.We performed a nested case–control study within a cohort of SLE women with singleton pregnancies. The study included 42 patients with SLE who eventually developed preeclampsia and 75 normal SLE pregnancies. Serum samples were collected at 4-week intervals (from weeks 12 to 36). Serum samples were analyzed for soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng).Results.Women destined to develop preeclampsia had lower PlGF levels and higher sFlt-1 and sEng levels, and a higher sFlt-1/PlGF ratio than normal pregnancies. These changes became significant at 12 weeks in patients destined to develop either early onset (< 34 weeks, p ≤ 0.003) or late-onset preeclampsia (≥ 34 weeks, p ≤ 0.02). The risk to develop preeclampsia was higher among patients with PlGF concentration values in the lowest quartile or with sFlt-1 and sEng levels, and sFlt-1/PlGF ratio, in the highest quartile of the normal SLE pregnancies distribution. The OR were higher and appeared earlier in patients destined to develop early onset preeclampsia (OR ≥ 16.2, from Week 12 onward) than in patients who presented preeclampsia later (OR ≥ 8.9, from Week 24 onward).Conclusion.Changes in circulating concentrations of sFlt-1, PlGF, sEng, and the sFlt-1/PlGF ratio precede the onset of preeclampsia in SLE pregnancies. The risk profile of circulating angiogenic factors for developing preeclampsia distinctly evolves depending on whether this condition is manifested earlier or later.

scholarly journals Altered Maternal Serum Matrix Metalloproteinases MMP-2, MMP-3, MMP-9, and MMP-13 in Severe Early- and Late-Onset Preeclampsia

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Marzena Laskowska
Keyword(s):  
Matrix Metalloproteinases ◽  
Pregnant Women ◽  
Immunosorbent Assay ◽  
Early Onset ◽  
Late Onset ◽  
Maternal Serum ◽  
Enzyme Linked Immunosorbent Assay ◽  
Healthy Controls ◽  
Control Subjects ◽  
Early Onset Preeclampsia

Objective. The aim of this study was to determine whether maternal serum matrix metalloproteinases 2, 3, 9, and 13 levels differ in early- and late-onset preeclampsia and uncomplicated pregnancies. Patients and Methods. The study was carried out in 125 pregnant women (29 with early-onset preeclampsia; 31 preeclamptic patients with late-onset preeclampsia; and 65 healthy pregnant controls). Levels of MMP-2, MMP-3, MMP-9, and MMP-13 were measured in the maternal serum using an enzyme-linked immunosorbent assay. Results. Maternal serum MMP-2 levels in both the groups of preeclamptic women were significantly higher than those in the controls. Levels of MMP-3 were significantly higher in preeclamptic patients with early-onset disease; however, the MMP-3 levels in patients with late-onset preeclampsia were similar to those observed in the control subjects. MMP-9 levels were lower whereas the levels of MMP-13 were higher in both preeclamptic groups of pregnant women than in the healthy controls, but these differences were statistically insignificant. Conclusions. One important finding of the present study was that MMP-3 appears to be involved solely in early-onset preeclampsia, but not in late-onset preeclampsia. Higher levels of MMP-2 and MMP-13 and lower levels of MMP-9 seem to be related to both early- and late-onset severe preeclampsia.

scholarly journals COVID-19 causing HELLP-like syndrome in pregnancy and role of angiogenic factors for differential diagnosis

2020 ◽  
Author(s):  
Francesc Figueras ◽  
Elisa LLurba ◽  
Raigam Martinez-Portilla ◽  
Josefina Mora ◽  
Fatima Crispi ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Hellp Syndrome ◽  
Angiogenic Factors ◽  
Consecutive Series ◽  
Elevated Liver Enzymes ◽  
Low Platelet Count ◽  
False Diagnosis ◽  
Elevated Transaminases ◽  
Plgf Ratio ◽  
In Pregnancy

Importance: The clinical presentation of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is one of the more severe forms of preeclampsia. COVID-19 infection exhibits signs that are shared with preeclampsia and HELLP syndrome, which may lead to needless interventions and iatrogenic preterm delivery. Objective: We evaluated the prevalence of HELLP-like signs in pregnant women admitted for COVID-19 and the value of angiogenic factors to rule out preeclampsia. Methods: a consecutive series of 27 pregnant women beyond 20 weeks of gestation, with symptomatic COVID-19. Clinical and analytical features were recorded and those cases with signs of HELLP syndrome were tested for sFlt-1/PlGF ratio. Results: Seven patients (25.9%) presented at least one sign of suspected HELLP syndrome, of which 2 (7.4%) were diagnosed clinically with PE because of hypertension and high transaminases and 5 (18.5%) had only elevated transaminases. sFlt-1/PlGF ratio was normal in 6 of 7. Conclusion: Symptomatic COVID-19 may simulate severe preeclampsia in pregnancy. Angiogenic factors may be essential to avoid false diagnosis and needless interventions. These data were presented in a Virtual Symposium on Covid-19 and Pregnancy on 17 April: 2020:(http://medicinafetalbarcelona.org/simposiocovid19/ [Spanish] and https://medicinafetalbarcelona.org/symposiumcovid19/ [English]

scholarly journals Are There Differences in the Anthropometric, Hemodynamic, Hematologic, and Biochemical Profiles between Late- and Early-Onset Preeclampsia?

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Márcia Aires Rodrigues de Freitas ◽  
Alice Vieira da Costa ◽  
Luciana Alves de Medeiros ◽  
Mario da Silva Garrote Filho ◽  
Angélica Lemos Debs Diniz ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Early Onset ◽  
Doppler Ultrasonography ◽  
Late Onset ◽  
Tertiary Hospital ◽  
Hemodynamic Changes ◽  
Osmotic Stability ◽  
Biochemical Profiles ◽  
Early Onset Preeclampsia ◽  
Transversal Study

Preeclampsia (PE) is classified as early-onset PE (EOPE) and late-onset PE (LOPE) when present before or after 34 weeks of gestation, respectively. This transversal study aimed to investigate the differences and possible associations existing in the anthropometric, hemodynamic, hematologic, and biochemical profiles of late- and early-onset preeclampsia. The study included 65 volunteers admitted to a tertiary hospital in Brazil: 29 normotensive and 36 with preeclampsia (13 with EOPE and 23 with LOPE). Pregnant women with LOPE presented greater weight gain and borderline increase in body mass index at the end of gestation in relation to the other groups, which is compatible with the metabolic origin, associated with obesity, attributed to this form of the disease. Pregnant women with EOPE presented a borderline reduction in the number of erythrocytes and a significant decrease in the number of platelets, in addition to a significant increase in reticulocytes, serum iron, and ferritin when compared to normotensive pregnant women and pregnant women with LOPE. A significant increase in osmotic stability of erythrocytes was observed in the EOPE group in relation to other groups. Hemodynamic analysis by Doppler ultrasonography of the ophthalmic artery showed that both groups of pregnant women with PE presented alterations compatible with the occurrence of hyperflow in the orbital territory. These hemodynamic changes were associated with changes in hematimetric indices.

scholarly journals Role of pregravid body mass and its gestational increase in development of various variants of preeclampsia

2020 ◽  
pp. 11-15
Author(s):  
K. B. Pokusaeva ◽  
A. S. Krivenko ◽  
N. Yu. Katkova ◽  
V. N. Pokusaeva ◽  
A. S. Vakhrushin
Keyword(s):  
Body Weight ◽  
Pregnant Women ◽  
Fat Mass ◽  
Early Onset ◽  
Late Onset ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Increased Risk ◽  
Negative Effect ◽  
Early Onset Preeclampsia

Aim. To evaluate the effects of maternal pre-pregnancy body weight and excessive gestational weight gain (GWG) on the risk of different subtypes of preeclampsia (PE).Methods. A cohort study of 289 pregnant women: 41 with early-onset (less than 34 weeks) preeclampsia (EPE), 76 with late-onset (more than 34 weeks) preeclampsia (LPE) and 172 normotensive women (control). Associations between anthropometric indicators (pre-pregnancy BMI, GWG, fat mass in the 1st, 2nd, 3rd trimesters, on the 2–3rd day after birth) and risk of PE and its subtypes were evaluated.Results. Pre-pregnancy body weight (r = 0.36; р = 0.000) and BMI (r = 0.38; р = 0.000) moderately increased risk of PE. GWG had independent risk of developing PE (r = 0.46; р = 0.000). Women with excessive GWG had an increased risk of PE in normal BMI (RR = 2.2; р = 0.019), in overweigh (RR = 2.7; р = 0.028), in obese (ОР = 5.2; р = 0.000). The risk of developing preeclampsia increased in normal weight with GWG more than 500 g per week in the 2nd trimester (р = 0.000) and more than 400 g per week in the 3d trimester (р = 0.000), total GWG more than 16.5 kg increased risk of preeclampsia in 3.4-fold (ОР = 3.4; р = 0.001). Overweight and obesity had an increased risk of late-onset preeclampsia (RR = 4.9; р = 0.000). No association was found for early-onset preeclampsia (p > 0.050). Gestational metabolic disorders were independent risk of LPE: weekly GWG and the per cent of fat mass in normal weight pregnant women with LPE were significantly higher compared to the women with EPE and control. The per cent of fat mass in the 1st trimester in PPE (23.90 ± 4.40 %) exceeded control (20.50 ± 4.30 %; р = 0.003) and EPE (21.20 ± 3.65 %; р = 0.008) groups. Differences were aggravated during pregnancy (р < 0.050).Conclusions. Pre-pregnancy overweight and obesity, excessive GWG and gain of fatty mass were an independent risk of developing PE with synergistic negative effect. Pre-pregnancy and gestational lipid dismetabolism were associated with LPE. Our results suggested that no correlation between pre-pregnancy BMI, GWG, fatty mass and risk of EPE.

scholarly journals Decision Threshold for Kryptor sFlt‐1/PlGF Ratio in Women With Suspected Preeclampsia: Retrospective Study in a Routine Clinical Setting

2021 ◽  
Author(s):  
Lise Lotte Torvin Andersen ◽  
Annemarie Helt ◽  
Lene Sperling ◽  
Martin Overgaard
Keyword(s):  
Retrospective Study ◽  
Early Onset ◽  
Operating Characteristic ◽  
Late Onset ◽  
Characteristic Curve ◽  
Predictive Performance ◽  
Decision Threshold ◽  
Operating Characteristic Curve ◽  
Early Onset Preeclampsia ◽  
Plgf Ratio

Background The objective was to evaluate predictive performance and optimal decision threshold of the Kryptor soluble fms‐like tyrosine kinase‐1 (sFlt‐1)/placental growth factor (PlGF) ratio when implemented for routine management of women presenting with symptoms of preeclampsia. Methods and Results Observational retrospective study of a cohort of 501 women with suspected preeclampsia after 20 weeks of gestation. Women referred to maternity ward for observation of preeclampsia had an sFlt‐1/PlGF ratio test included in routine diagnostic workup. Maternal and offspring characteristic data included maternal risk factors, outcomes, delivery mode, and indication for suspected preeclampsia. Biochemical measurements to determine sFlt‐1/PlGF ratio were performed using the BRAHMS/Kryptor sFlt‐1/PlGF ratio immunoassays. Results were analyzed by area under receiver‐operating characteristic curve. Preeclampsia occurred in 150 of 501 (30%) of symptomatic women with an sFlt‐1/PlGF ratio determined before the time of diagnosis. Area under receiver‐operating characteristic curve for diagnosis of early‐onset preeclampsia within 1 and 4 weeks was 0.98 (95% CI, 0.96–1.00) and 0.95 (95% CI, 0.92–0.98), respectively. For late‐onset preeclampsia, predictive performance within 1 and 4 weeks was lower: 0.90 (95% CI, 0.85–0.94) and 0.85 (95% CI, 0.80–0.90), respectively. The optimal single sFlt‐1/PlGF ratio threshold for all preeclampsia and late‐onset preeclampsia within 1 and 4 weeks was 66. The negative and positive predictive values for ruling out and ruling in developing preeclampsia within 1 week were 96% and 70%, respectively. Conclusions The Kryptor sFlt‐1/PlGF ratio is a useful clinical tool ruling out and in preeclampsia within 1 week. Prediction within 4 weeks is superior for early‐onset preeclampsia. A single decision threshold of 66 is indicated for use in clinical routine.

Maternal complications of fetal triploidy: a case report

2020 ◽  
Vol 13 (10) ◽  
pp. e236950
Author(s):  
Sarah Wali ◽  
Marianne Wild
Keyword(s):  
Liver Enzymes ◽  
Late Onset ◽  
Ovarian Hyperstimulation ◽  
Second Trimester ◽  
Maternal Complications ◽  
Medical Termination ◽  
Elevated Liver Enzymes ◽  
Low Platelet Count ◽  
Early Onset Preeclampsia

A 32-year-old woman underwent a medical termination in the second trimester of a spontaneously conceived triploid pregnancy after developing early-onset preeclampsia with subsequent haemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Placental histology was normal (non-molar) and unusually, she developed ovarian hyperstimulation syndrome (OHSS) 4 weeks later. She was managed conservatively following multidisciplinary team input to exclude malignant pathology. The rarity of late-onset spontaneous OHSS could have resulted in inappropriate surgical management. In the absence of supportive treatment there is also a risk of the condition progressing to a critical stage. Follow-up ultrasonography after termination of pregnancy should be considered for women with evidence of ovarian hyperstimulation, particularly if other risk factors for OHSS are present. Delayed-onset OHSS should be considered in women presenting with bilateral cystic ovarian enlargement after triploid pregnancy.

scholarly journals Mean arterial blood pressure: potential predictive tool for preeclampsia in a cohort of healthy nulliparous pregnant women

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jussara Mayrink ◽  
◽  
Renato T. Souza ◽  
Francisco E. Feitosa ◽  
Edilberto A. Rocha Filho ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pregnant Women ◽  
Arterial Blood Pressure ◽  
Mean Arterial Blood Pressure ◽  
Early Onset ◽  
Late Onset ◽  
Roc Curves ◽  
Predictive Tool ◽  
Arterial Blood ◽  
Early Onset Preeclampsia

Abstract Background Prediction of preeclampsia is a challenge to overcome. The vast majority of prospective studies in large general obstetric populations have failed in the purpose of obtain a useful and effective model of prediction, sometimes based on complex tools unavaible in areas where the incidence of preeclampsia is the highest. The goal of this study was to assess mean arterial blood pressure (MAP) levels at 19–21, 27–29 and 37–39 weeks of gestation and performance of screening by MAP for the prediction of preeclampsia in a Brazilian cohort of healthy nulliparous pregnant women. Methods This was a cohort approach to a secondary analysis of the Preterm SAMBA study. Mean arterial blood pressure was evaluated at three different time periods during pregnancy. Groups with early-onset preeclampsia, late-onset preeclampsia and normotension were compared. Increments in mean arterial blood pressure between 20 and 27 weeks and 20 and 37 weeks of gestation were also calculated for the three groups studied. The accuracy of mean arterial blood pressure in the prediction of preeclampsia was determined by ROC curves. Results Of the 1373 participants enrolled, complete data were available for 1165. The incidence of preeclampsia was 7.5%. Women with early-onset preeclampsia had higher mean arterial blood pressure levels at 20 weeks of gestation, compared to the normotensive group. Women with late-onset preeclampsia had higher mean arterial blood pressure levels at 37 weeks of gestation, than the normotensive groups and higher increases in this marker between 20 and 37 weeks of gestation. Based on ROC curves, the predictive performance of mean arterial blood pressure was higher at 37 weeks of gestation, with an area under the curve of 0.771. Conclusion As an isolated marker for the prediction of preeclampsia, the performance of mean arterial blood pressure was low in a healthy nulliparous pregnant women group. Considering that early-onset preeclampsia cases had higher mean arterial blood pressure levels at 20 weeks of gestation, future studies with larger cohorts that combine multiple markers are needed for the development of a preeclampsia prediction model.

Early-Onset Preeclampsia with Pulmonary Edema and Massive Ascites: A Rare Presentation of Severe Preeclampsia or Concomitant Diagnoses?

2020 ◽  
Vol 2020 ◽  
Author(s):  
Elizabeth St. Laurent ◽  
Rebecca Fryer-Gordon ◽  
Tom McNeilis, ◽  
Leonard B. Goldstein
Keyword(s):  
Pulmonary Edema ◽  
Early Onset ◽  
Hellp Syndrome ◽  
Disease Process ◽  
Massive Ascites ◽  
Elevated Liver Enzymes ◽  
Biophysical Profile ◽  
Patient Reported ◽  
Early Onset Preeclampsia ◽  
New Onset

Preeclampsia, eclampsia, and HELLP syndrome, are a continuum of a dangerous disease process that can occur in pregnancy. Preeclampsia is defined by new onset hypertension and proteinuria. In more severe cases, preeclampsia can be associated with pulmonary edema, oliguria, persistent headaches, and impaired liver function. These symptoms reveal maternal end organ damage which may result in danger to the fetus such as oligohydramnios, decreased fetal growth, and placental abruption. The defining difference between preeclampsia and eclampsia is the presence of new onset seizure activity. HELLP syndrome occurs when the mother experiences hemolysis, elevated liver enzymes, and low platelets. This syndrome is seen in about 0.6% of pregnancies. Each of these conditions (preeclampsia, eclampsia, and HELLP) increase both the fetal and maternal morbidity and mortality rates with the most definitive cure being delivery of child and placenta.A 28 year-old Caucasian, G1P0 female at 26w4d presented to OB triage on the recommendation of her physician due to elevated uric acid levels and a recorded blood pressure of 180/110. The patient reported rapid onset of weight gain, facial edema, diminished fetal movements, and frequent headaches. Although the patient denied labor symptoms, she complained of back pain and was admitted to the hospital at 26w4d for observation due to elevated blood pressures. The patient was diagnosed with preeclampsia with severe features. As her presentation progressed, the patient developed massive ascites and pulmonary edema along with decreasing platelet counts and increasing liver enzyme values. Due to decreasing biophysical profile (BPP) scores of the fetus and decompensating lab values of the mother, an emergency cesarean was performed for the safety of mother and baby.This case presentation demonstrates the progression of hypertensive disorders of pregnancy with a rare and severe presentation of early-onset preeclampsia with severe features, pulmonary edema, and massive ascites that ultimately led to class III HELLP syndrome and extreme prematurity of the infant.

Sign in / Sign up

Export Citation Format

Share Document