Diagnostic Accuracy of Different Soluble fms-Like Tyrosine Kinase 1 and Placental Growth Factor Cut-Off Values in the Assessment of Preterm and Term Preeclampsia: A Gestational Age Matched Case-Control Study.

Evelyn A Huhn,Andreas Schoetzau,Olav Lapaire,Andrea Kreienbühl,Irene Hoesli,Begona Martinez De Tejada,Ina Hoffmann,Martin Hund,Soeren Lange

doi:10.3389/fmed.2018.00325

Evelyn A Huhn, Andreas Schoetzau + Show 7 more

Open Access

https://doi.org/10.3389/fmed.2018.00325

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Abstract

Introduction: The objective was to investigate the diagnostic accuracy of different thresholds of the soluble vascular endothelial growth factor receptor-1 (sFlt-1) and the placental growth factor (PlGF) in preterm (≤37 weeks) and term (>37 weeks) preeclampsia (PE).Materials and Methods: A nested case-control study was performed from a high-risk Swiss cohort. Only blood samples on the day of PE diagnosis were included. The primary outcome was to verify the diagnosis using the recently proposed cut-off values for PE (sFlt-1:PlGF ratio of ≥85 in ≤ 34 weeks or ≥110 in >34 weeks), and the gestational age dependent centiles.Results: Thirty-four women with preterm PE were matched with 64 controls and 25 women with term PE with 45 controls. The test performance of the sFlt-1:PlGF ratio in preterm PE was very good (AUROCC of 0.95). The sFlt-1:PlGF ratio could adequately predict adverse fetal or neonatal outcome. In term PE, sFlt-1 alone showed a slightly better diagnostic accuracy with an AUROCC of 0.84. Almost all women with a sFlt-1:PlGF ratio above threshold delivered during the following week.Discussion: In pregnant women with high risk of developing PE, the sFlt-1:PlGF ratio and sFlt-1 levels help clinicians to confirm the diagnosis of imminent preterm PE and can additionally be used to rule out PE at term.

Highlights

The objective was to investigate the diagnostic accuracy of different thresholds of the soluble vascular endothelial growth factor receptor-1 and the placental growth factor (PlGF) in preterm (≤37 weeks) and term (>37 weeks) preeclampsia (PE)
In preterm PE, the sFlt-1:PlGF ratio, PlGF, and sFlt-1 and show similar performance [area under the receiver operating characteristic curve (AUROCC) of sFlt-1:PlGF ratio 0.95, PlGF 0.94 and sFlt-1 0.94] and in term PE, sFlt-1 seems to be slightly better in detecting PE with an AUROCC of 0.84 vs. the sFlt-1:PlGF ratio [0.79]and PlGF alone [0.68]
Our study showed that the discrimination of term PE vs. its GAmatched high-risk control group reached not the high diagnostic accuracy using the sFlt-1:PlGF ratio

Summary

Introduction

The objective was to investigate the diagnostic accuracy of different thresholds of the soluble vascular endothelial growth factor receptor-1 (sFlt-1) and the placental growth factor (PlGF) in preterm (≤37 weeks) and term (>37 weeks) preeclampsia (PE). Four of five PE events occur >37 weeks of gestation (WOG) [3]. Term PE is less often associated with placental dysfunction and the fetus is less threatened with intrauterine growth restriction (IUGR) as in preterm PE. Term PE is by no means a benign condition. Severe fetal and maternal complications can occur. Twenty percent of the cases with HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome [4] and 55% of the cases with eclampsia develop in term PE [5]

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