Faculty Opinions recommendation of Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia.

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

10.1055/s-0038-1671477 ◽

2018 ◽

Author(s):

S Enengl ◽

P Trautner ◽

O Shebl ◽

P Oppelt ◽

PE Le Renard ◽

...

Keyword(s):

Preliminary Data ◽

Predictive Value ◽

Time To Delivery ◽

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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Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia

New England Journal of Medicine ◽

10.1056/nejmoa1414838 ◽

2016 ◽

Vol 374 (1) ◽

pp. 13-22 ◽

Cited By ~ 563

Author(s):

Harald Zeisler ◽

Elisa Llurba ◽

Frederic Chantraine ◽

Manu Vatish ◽

Anne Cathrine Staff ◽

...

Keyword(s):

Predictive Value ◽

Plgf Ratio

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The Prognostic Value of Angiogenic Markers in Twin Pregnancies to Predict Delivery Due to Maternal Complications of Preeclampsia

Hypertension ◽

10.1161/hypertensionaha.120.14957 ◽

2020 ◽

Vol 76 (1) ◽

pp. 176-183 ◽

Cited By ~ 1

Author(s):

Julia Binder ◽

Pilar Palmrich ◽

Petra Pateisky ◽

Erkan Kalafat ◽

Lorenz Kuessel ◽

...

Keyword(s):

Predictive Value ◽

Predictive Accuracy ◽

Area Under The Curve ◽

Blood Sampling ◽

Maternal Complications ◽

Retrospective Data Analysis ◽

Twin Pregnancies ◽

Plgf Ratio ◽

Rule Out ◽

Singleton Pregnancies

The sFlt-1 (soluble fms-like tyrosine kinase-1), PlGF (placental growth factor), and their ratio are useful for predicting delivery because of preeclampsia in singleton pregnancies. Evidence on the utility of sFlt-1/PlGF ratio in twin pregnancies is lacking. We aimed to evaluate the predictive value of sFlt-1/PlGF ratio for delivery because of preeclampsia in twins. A retrospective data analysis of 164 twin pregnancies with suspected preeclampsia was performed. The sFlt-1/PlGF ratio, which was known to clinicians, was significantly higher in women who delivered within 1 and 2 weeks compared with those who did not (median: 98.9 and 84.2 versus 23.5 pg/mL, respectively; P <0.001). The area under the curve values sFlt-1/PlGF ratio levels were 0.88 (95% CI, 0.83–0.84) and 0.88 (95% CI, 0.83–0.93) for predicting delivery because of preeclampsia within 1 and 2 weeks of blood sampling, respectively. The predictive accuracy of sFlt-1/PlGF was independent of gestational age at sampling and chorionicity ( P >0.100 for interaction). The area under the curve values of sFlt-1/PlGF were significantly higher than for PlGF alone (mean 0.88 and 0.88 versus 0.81 and 0.80) for predicting delivery because of preeclampsia within 1 and 2 weeks of blood sampling ( P =0.055 and 0.001, respectively). sFlt-1/PlGF ratio lower than 38 was able to rule-out delivery within 1 and 2 weeks with a negative predictive value of 98.8% and 96.4% for delivery because of preeclampsia within 1 and 2 weeks, respectively. A cutoff of 38 is applicable for ruling out delivery because of preeclampsia in twin pregnancies.

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