OP 18 Comparing the sflt-1/plgf ratio with other biomarkers as a predictive test for pre-eclampsia – A clinical audit

Abstract

Introduction The recently published PROGNOSIS study (NEJM 2016 374:1:13–22) demonstrated the sFlt-1/PlGF ratio biomarker test to have significant clinical utility as a stand-alone predictive investigation for the assessment of patients with suspected pre-eclampsia (PE). Before implementation of the sFlt-1/PlGF test into routine local practice, clinical superiority and cost-effectiveness compared to current alternate investigations for the evaluation of patients with suspected pre-eclampsia must be demonstrated. Objective To compare the test characteristics of investigations currently utilised in the assessment of suspected pre-eclampsia with the sFlt-1/PlGF ratio in a retrospective audit of such cases managed in a pregnancy day care centre (PDCC) setting in a tertiary perinatal centre in Melbourne, Australia. Methods The audit was performed over 4 months at the Royal Women”s Hospital, Melbourne, Australia. Patients included in the audit were greater than 20 weeks gestation and were admitted to the PDCC following an initial observation of hypertension. Four repeat one-hourly blood pressure measurements were taken for each patient. Urine protein-creatinine ratio (PCR), blood platelets, hepatic enzymes (ALT, ALP, GGT), haemoglobin (Hb) and the sFlt-1/PlGF ratio investigation were performed. The test characteristics of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined for each investigation. Results 197 women were included in the audit. Of these, 67 were classified as normal, 72 as pregnancy-induced hypertension (PIH), 52 as PE and 6 as HELLP syndrome cases. Normal and PIH cases were combined into a ”non-PE” group for control analysis. PE and HELLP cases were combined for ”PE” case analysis. The prevalence value for PE utilised in analysis was 29.4%. Based on the investigation result nearest to delivery, test characteristics for each investigation were calculated (Fig. 1). The sFlt-1/PlGF ratio biomarker demonstrated the best negative predictive value with 94.07%. Conclusion This audit validates the superiority of the sFlt-1/PlGF ratio biomarker test in the prediction of PE compared with current alternate investigations in an Australian pregnancy day care setting. Download : Download high-res image (205KB) Download : Download full-size image