Diagnostic Tool For Preeclampsia Research Articles

#1059 Value of urine transcription factor 21 as a diagnostic tool for preeclampsia

Abstract Background and Aims Prediction of pre-eclampsia early in pregnancy can reduce its incidence and subsequent maternal and fetal morbidity and mortality. The sensitivity of current biomarkers is fair despite being used in clinical settings. Podocyturia was found to be a useful biomarker of preeclampsia with high sensitivity and specificity. UTF21 is highly expressed on podocytes. We investigated the relationship between urine transcription factor 21 as a new biomarker and preeclampsia. Method 160 pregnant women with pre-eclampsia and age and gestational age matched 64 pregnant women with normal pregnancy were recruited. Pre-eclamptic patients were subdivided into mild (92 pregnant patients) and severe (68 pregnant patients). Each group is subdivided into early-onset and late-onset preeclampsia. Urine transcription factor 21 and compared with serum PlGF and sFlts were measured. The sFlt/PlGF ratio was calculated. Results The mean Urine transcription factor 21 was significantly higher in pregnant patients with preeclampsia than in healthy pregnant controls (512.3 ± 281.4 vs. 300 ± 66.8; p<0.001). Urine TCF21 could not differentiate between early- and late-onset preeclampsia with the mean urine TCF21 was higher in early-onset preeclampsia than late-onset preeclampsia (532.63 ± 312.33 vs. 491.41 ± 248.1, p=0.519). Urine TCF21 was statistically significantly higher in mild preeclampsia than severe preeclampsia (572.3 ± 300.9 vs. 361.9 ± 155.8, p<0.001). The sensitivity and specificity of urine TCF21 was 60.62% and 90.62% when using 370 pg/mL as cutoff in the prediction of preeclampsia development. Conclusion Urine transcription factor 21 can be used as a possible and easy diagnostic marker for preeclampsia. It can differentiate between mild and severe preeclampsia but cannot be used to differentiate between early- and late-preeclampsia.

Hepatocyte growth factor and epidermal growth factor in HIV infected women with preeclampsia

ObjectivesEpidermal growth factor (EGF) and Hepatocyte growth factor (HGF) both have tyrosine kinase receptors (EGFR and c-Met) which upon binding, activates and regulates many important cellular processes such as cell survival, growth, proliferation, differentiation, invasion, repair and so forth via the RAS/MAPK/ERK1/2, PI3K/AKT and JAK STAT3 pathways. These processes are crucial for the development of a placenta and other functions in order for a normal pregnancy to occur. Hence, this study determined the concentrations of HGF and EGF to find the correlation between HIV and preeclampsia (PE). Study designA total sample size of n = 80 was used, n = 40 preeclamptic women and n = 40 normotensive women these were further stratified into HIV-positive and HIV-negative women. Analysis of the growth factors were done by using the multiplex Bio-Plex immunoassay method. ResultsIrrespective of HIV status, based on pregnancy type, EGF in PE women displayed an upregulation compared to normotensive women. However, for HGF no variance was found between pregnancy type.Based on HIV status, regardless of pregnancy type, both HGF and EGF levels were significantly increased in HIV-positive women compared to HIV-negative women.Across all groups for HGF, significant difference was found between HIV-negative normotensive women (lower) vs HIV-positive normotensive women (higher).Nevertheless, for EGF across all groups, a statistically significant decrease was found in HIV-negative normotensive women compared to HIV-positive normotensive women, HIV-positive PE women and HIV-negative PE women. ConclusionThe study demonstrates that there is a strong association between HIV and PE and that HGF and EGF are promising biomarkers to use as a diagnostic tool for PE.

Zeta potential as a novel diagnostic tool for preeclampsia

To determine the zeta potential of erythrocyte and its association with morphological changes during preeclampsia so as to use it as a diagnostic tool to determine this pregnancy related complication. This retrospective study included 502 pregnant women. Blood samples were collected in 5% dextrose solution from preeclampsia patients (n = 92) and normal pregnant women (n = 337). Zeta potential (ZP) of the erythrocyte was measured using Zeta meter System 4.0 equipped with zetameter-ZM4DAQ software using microscopically acquired video images. The experimental data was analysed using One Way analysis of variance using GraphPad Prism 5 Project software for Windows. In the present study, mean erythrocytic ZP of pregnant women in each trimester was found to be17.22 mV, 20.159 mV and 20.92 mV for the first, second and third trimester respectively. Whereas for control pregnant women it was found to be 21.07 ± 0.3393 mV and for preeclampsia patients it was found to be 15.13 ± 0.1393 mV which was significantly less than that of control pregnant volunteers along with structural deformity and increased osmotic fragility of erythrocytes. The data suggest that as pregnancy progresses there is increase in ZP values whereas in preeclampsia there is significant decrease in the ZP values below the normal level. This decrease in ZP values can be seen in early stages of pregnancy, which is difficult to diagnose by other available diagnostic tests. So, that early treatment can be started and development of further complications in mother as well as foetus can be avoided.

Serum sFlt-1/PlGF ratio has better diagnostic ability in early- compared to late-onset pre-eclampsia.

Background To establish gestational specific cutoffs for the soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) ratio as a diagnostic tool for pre-eclampsia (PE) in an Asian population. Methods 82 subjects (48 PE patients and 34 controls) were recruited. sFlt-1 and PlGF were analysed on the Roche Cobas e411 analyzer and their ratio was calculated. Diagnostic performance was evaluated using receiver-operating characteristics (ROC) curves. Optimal cutoffs for sFlt-1/PlGF ratio were determined for different gestation phases. Results The most optimal cut-off for the study group is 32 with a sensitivity and specificity of 85.1% and 100% and Youden Index (J) of 0.85. Applying this cutoff for early-onset PE (EO-PE), sensitivity increased to 95.8% while specificity remains at 100% (J=0.96). However, for late onset PE (LO-PE), sensitivity decreases to 73.9% while specificity remains at 100% (J=0.74). Two cutoffs were further determined for EO-PE and LO-PE - the first focusing on high sensitivity; the second focusing on high specificity. For EO-PE, cutoff <17 yielded sensitivity of 100% and specificity of 94.4% (J=0.94) while cutoff ≥32 yielded sensitivity of 95.8% and specificity of 100% (J=0.95). For LO-PE, cutoff <22 has a sensitivity of 82.6% and a specificity of 91.7% (J=0.74) while cutoff ≥32 yielded sensitivity of 73.9% and specificity of 100% (J=0.74). Conclusion While our study found an overall cutoff at 32 regardless of gestation age, it has limited diagnostic accuracy for LO-PE in our study. Multiple cutoffs focusing on either high sensitivity or high specificity enhance the performance of the sFlt-1/PlGF ratio as a diagnostic tool for PE and contribute to the identification of women at risk of PE in our Asian region.

Prenatal Clinical Assessment of NT-proBNP as a Diagnostic Tool for Preeclampsia, Gestational Hypertension and Gestational Diabetes Mellitus.

Common complications of pregnancy include preeclampsia (PE), gestational hypertension (GH) and gestational diabetes mellitus (GDM). Hypertensive disorders (PE/GH) and GDM may result in greater maternal, fetal and neonatal morbidity and mortality. Women with PE/GH, one of the most common causes of heart burden in an obstetrical setting, present with elevated serum levels of BNP and NT-proBNP. The aim of this study was to shed more light on the role of NT-proBNP in pathophysiology of PE, GH and GDM. The study included 156 pregnant women with singleton pregnancies. A total of 26 women developed arterial hypertension during pregnancy, 14 were diagnosed with PE, and GDM was detected in 81 patients. The control group included 35 women with uncomplicated pregnancies, normal arterial blood pressure and normal glucose concentrations. Patients with GH presented with significantly higher serum concentrations of NT-proBNPthan normotensive women (65.5 vs. 37.4 pg/ml; p = 0.0136). Serum levels of NT-proBNP in patients with PE were the highest of all the analyzed subsets, being significantly higher than in women without this condition (89.00 vs. 37.4pg/ml,p = 0,0136). However, women with and without GDM did not differ significantly in terms of their serum NT-proBNPconcentrations. Serum NT-proBNP (pg/ml) (p = 0.0001) and BMI (p<0.0001) turned out to be independent predictors of GH on multivariate logistic regression analysis.Moreover, serum NT-proBNP (pg/ml) was identified as an independent indicator of PE (p = 0.0016). A significant inverse correlation was found between birth weight and maternal serum NT-proBNP concentrations. In our opinion, NT-proBNP can be a useful clinical marker of GH and PE. Determination of NT-proBNP levels may be helpful in identification of patients with PE and GH and in their qualification for intensive treatment; this in turn, may be reflected by better neonatal outcomes.

OP.5D.07] ANGIOGENIC IMBALANCED PREECLAMPSIA VERSUS CLINICAL PREECLAMPSIA

Objective: The ratio of the maternal plasma angiogenic factors soluble Fms-kinase 1 (sFlt-1) and placental growth factor (PlGF) is a novel diagnostic tool for preeclampsia (PE), with a value <38 predicting short-term absence of PE in women in whom the syndrome is suspected clinically. The clinical implication of a single determination below the sFlt-1/PlGF ratio of 38 beyond 1 week remains to be established. We therefore assessed the evolution of the sFlt-1/PlGF ratio in patients suspected of PE on clinical grounds. Design and method: In this ongoing study, using the Elecsys assays (Roche Diagnostics), the sFlt:1/PlGF ratio was determined at >2 time points in 39 pregnant women with suspected PE (new onset or aggravation of hypertension and/or proteinuria; renal insufficiency [serum creatinine >100 μmol/l]; neurological complications [severe headache, hyperreflexia, persistent visual scotoma, blindness, stroke, seizures]; severe edema or HELLP symptoms [right upper quadrant/epigastric abdominal pain; elevated transaminases; thrombocytopenia; hemolysis]). Results: In 39 patients with singleton pregnancies, aged 23–44 years and a median pregnancy duration of 28 weeks (range 20–37 weeks), the ratio of 6 (range 2–34) at inclusion remained constant for up to 100 days in patients with an underlying disease, including hypertension, proteinuria and other renal disease such as systemic lupus erythematosus, despite the fact that their protein-to-creatinine ratio and blood pressure often rose. In contrast, in patients with clinical PE or in whom (superimposed) PE eventually occurred based on clinical grounds (hypertension and proteinuria) the ratio of 67 (range 5–277) at inclusion rapidly increased further, often doubling every additional week. Of these patients with clinical PE 7 women had a ratio <38, nonetheless pregnancy in 6 of them could be prolonged for over 15 days or they delivered at term with mild features. Conclusions: Our findings indicate that patients without an angiogenic imbalance, i.e. an Elecsys sFlt-1/PlGF ratio of 38 and lower, carry a small risk of adverse events despite being diagnosed with PE on clinical grounds. The latter underscores the importance to highlight angiogenic imbalanced PE rather than the heterogeneous and less specific clinical diagnosis in future studies and clinical management.

44 Predictive value of repetitive measurement of sFlt-1:PLGF ratio in women with (suspected) preeclampsia

Introduction The ratio of the maternal plasma angiogenic factors soluble Fms-kinase 1 (sFlt-1) and placental growth factor (PlGF) is a novel diagnostic tool for preeclampsia (PE), with a value ⩽ 38 predicting short-term absence of PE in women in whom the syndrome is suspected clinically. The clinical implication of a single determination below the sFlt-1/PlGF ratio of 38 beyond 1 week remains to be established. Objective To assess the evolution of the sFlt-1/PlGF ratio in patients with (suspected) PE on clinical grounds. Methods In this ongoing observational study, the sFlt-1/PlGF ratio was determined (Elecsys assay, Roche Diagnostics) at ⩾ 2 time points in women with (suspected) PE based on the presence of ⩾ 1 of the following symptoms: new onset or aggravation of hypertension or proteinuria; renal insufficiency (serum creatinine > 100 μ mol/l); neurological complications (severe headache, hyperreflexia, persistent visual scotoma, blindness, stroke, seizures); severe edema or HELLP symptoms (right upper quadrant/epigastric abdominal pain; elevated transaminases; thrombocytopenia; hemolysis). Results We included 49 women (singleton pregnancies), aged 18-47 years and with a median pregnancy duration of 35 weeks (range 20-41 weeks). In those with a ratio ⩽ 38 (median 8 (range 2-37); n=30) at baseline, the ratio remained constant for up to 70 (range 26-107) days despite the fact that their protein-to-creatinine ratio and blood pressure often rose. In contrast, in those with a ratio > 38 (97 (range 42–991); n = 19) at inclusion, the ratio rapidly increased further, often doubling every week. Conclusions A sFlt-1/PlGF ratio at inclusion ⩽ 38, does not result in a further rise, while a steep rise occurs in those with an inclusion ratio > 38.

Diagnosis of preeclampsia with soluble Fms–like tyrosine kinase 1/placental growth factor ratio: an inter–assay comparison

The angiogenic factor ratio soluble Fms–kinase 1 (sFlt–1)/placental growth factor (PlGF) is a novel diagnostic tool for preeclampsia. We compared the efficacy of the KRYPTOR (BRAHMS) automated assays for sFlt–1 and PlGF with the Elecsys (Roche) assays in a routine clinical setting. Preeclamptic women (n = 39) were included shortly after the time of diagnosis. Normotensive control pregnancies were matched by gestational age (n = 76). The KRYPTOR assays performed comparably or superior to Elecsys (sFlt–1/PlGF area under the curve 0.746 versus 0.735; P = .09; for non–obese 0.820 versus 0.805, P = .047). For early–onset preeclampsia, KRYPTOR area under the curve increased to 0.929 with a 100% specificity for preeclampsia at cut–off 85 and an 88.9% sensitivity for preeclampsia at cut–off 33. For women with preeclampsia and preterm delivery or Hemolysis, Elevated Liver enzymes, Low Platelet count (HELLP) syndrome, the KRYPTOR sFlt–1/PlGF ratio was manifold increased (P < .01). The sFlt–1/PlGF ratio proved especially useful in early–onset preeclampsia, preeclampsia with preterm delivery or HELLP, and among non–obese women.

New Gestational Phase–Specific Cutoff Values for the Use of the Soluble fms-Like Tyrosine Kinase-1/Placental Growth Factor Ratio as a Diagnostic Test for Preeclampsia

To establish gestational phase adapted cutoffs for the use of the soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio as a diagnostic tool for preeclampsia in the clinical setting, a multicenter case-control study including a total of 1149 patients was performed. We report normal values of sFlt-1, PlGF, and the sFlt-1/PlGF ratio based on the analysis of a total of 877 patients with uneventful pregnancy outcome. A total of 234 patients with preeclampsia and a matched cohort consisting of 468 patients with normal pregnancy outcome were compared, and sFlt-1 and PlGF were measured on an automated platform. Separate cutoffs for the sFlt-1/PlGF ratio were determined for the early (20+0-33+6 weeks) and the late gestational phase (34+0 weeks-delivery). For each of the 2 gestational phases, 2 independent cutoffs framing an equivocal zone were determined: the first cutoff with focus on high sensitivity, and the second focusing on high specificity. Between 20+0 and 33+6 weeks, the cutoffs at ≤33 and ≥85 resulted in a sensitivity/specificity of 95%/94% and 88%/99.5%, respectively. An sFlt-1/PlGF ratio of ≤33 had the lowest likelihood of a negative test (0.05; 95% confidence interval, 0.02-0.13), whereas values ≥85 had the highest likelihood of a positive test (176; 95% confidence interval, 24.88-1245). After 34+0 weeks, the cutoffs at ≤33 and ≥110 yielded a sensitivity/specificity of 89.6%/73.1% and 58.2%/95.5%, respectively. The approach to use multiple cutoffs for the early and late gestational phase enhances the diagnostic accuracy of the sFlt-1/PlGF ratio as a diagnostic tool for preeclampsia.

Prenatal Clinical Assessment of sFlt-1 (Soluble fms-like Tyrosine Kinase-1)/PlGF (Placental Growth Factor) Ratio as a Diagnostic Tool for Preeclampsia, Pregnancy-induced Hypertension, and Proteinuria.

Background: Aim of the study was a critical assessment of the clinical validity of the prenatal determination of sFlt-1/PlGF for preeclampsia (PE), pregnancy-induced hypertension (PIH), and proteinuria. Our analysis was based on a specificity of 95 % and a sensitivity of 82 % for the prediction of preeclampsia, as described by Elecsys (Roche). Methods: In this retrospective study the ratio of the prenatal antiangiogenic factor sFlt-1 (soluble fms-like tyrosine kinase-1) to the proangiogenic factor PIGF (placental growth factor) was analyzed using the electrochemiluminescence immunoassay of Elecsys (Roche Diagnostics, Mannheim, Germany) in 173 pregnant women. Sixty-three women with PE, 34 women with PIH and 6women with proteinuria were compared to 72controls. On average, the sFlt-1/PlGF ratio was determined 8 (controls), 2.4 (PE), 3.2 (PIH) and 4.1 (proteinuria) weeks before delivery. The PE and PIH cases were further subdivided into early (< 34 weeks of gestation) and late (≥ 34 weeks of gestation) onset groups. Statistical data analysis was done using the usual descriptive statistics and logistic regression analysis. ROC curves were calculated, and the sensitivity, specificity, and negative and positive predictive value (NPV, PPV) were estimated for a threshold of 85. Results: Although the specificity of the sFlt-1/PlGF ratio was high for PE, the sensitivity was low (only 59.4 %), thus giving unsatisfying results for PE. The sensitivity only increased to 62.5 % for the early-onset PE group. Intriguingly, a high ratio was detected for the combination of IUGR (intrauterine growth restriction) and PE in the early-onset PE group (8 cases). In the control group, 4cases exceeded the cut-off value of 85 but showed no clinical signs of PE and the birth was unremarkable. In summary, we found that the sFlt-1/PIGF ratio could not be used as a predictive test for preeclampsia but rather as an indicator for the development and estimation of the severity of PE. Thus, the test is less suitable for the reliable exclusion of PE in routine clinical practice. Recommendation: The determination of the sFlT-1/PlGF ratio is only one element for PE diagnosis in addition to the measurement of blood pressure, proteinuria, ultrasound and Doppler.

Quantitative Polymerase Chain Reaction–Based Analysis of Podocyturia Is a Feasible Diagnostic Tool in Preeclampsia

Preeclampsia is a significant cause of maternal and fetal morbidity and mortality worldwide. A clinically useful screening test that can predict development of preeclampsia at an early stage is urgently needed. The detection of podocyturia by immunohistochemistry after cell culture has been noted as a reliable marker for preeclampsia. However, this method is laborious and carries the risk of cell culture contamination. The aim of this study was to investigate the diagnostic value of quantitative polymerase chain reaction as a rapid method to detect preeclampsia. Clean-catch urine samples were collected from preeclamptic (n=35), healthy pregnant (n=34), and healthy nonpregnant (n=12) women. Furthermore, a control group of women with gestational hypertension (n=5) was included. Quantitative polymerase chain reaction analysis was performed for podocyte-specific markers. Receiver operating characteristic curve analyses were performed. Significantly elevated mRNA levels of nephrin, podocin, and vascular endothelial growth factor were detected in preeclamptic women compared with healthy pregnant and healthy nonpregnant controls. In addition, significantly elevated levels of nephrin mRNA were detected in urine of preeclamptic women compared with women with gestational hypertension. A positive correlation (ρ=0.82; P<0.0001) was observed between nephrin and vascular endothelial growth factor mRNA levels in preeclamptic women. Receiver operating characteristic curve analyses demonstrated a strong ability of this method to discriminate between the different study groups. Quantitative polymerase chain reaction analysis of podocyte-specific molecules in urine samples is a rapid and reliable method to quantify podocyturia. We demonstrate that this method distinguishes preeclamptic patients from healthy controls and women with gestational hypertension. This method may be a tool for the detection of preeclampsia at an earlier stage, thereby preventing maternal and fetal morbidity and mortality.

OS092. qPCR-based analysis of podocyturia is a feasible diagnostic tool in preeclampsia

Preeclampsia affects 5% of all pregnancies and is a significant cause of maternal and fetal morbidity and mortalityworldwide. A clinically useful screening test that can predict the development of preeclampsia at an early stage is urgently needed. The detection of podocyturia by immunohistochemistry following cell culture has been noted as a sensitive and specific marker for preeclampsia. However, this method is laborious and carries the risk of cell-culture contamination. The aim of this study was to investigate the diagnostic value of qPCR as a rapid and sensitive method to detect podocyturia in women with preeclampsia. Mid-stream urine samples were collected from preeclamptic [1] (n=35), healthy pregnant matched for gestational age (n=34), and healthy non-pregnant (n=12) women. mRNA was isolated using the Trizol method. qPCR analysis was performed for nephrin, VEGF, podocin, GAPDH and megalin transcripts. A ROC-curve analysis was performed. Significantly elevated mRNA expression levels of nephrin, podocin and VEGF were detected in preeclamptic women compared to healthy pregnant and healthy non-pregnant controls. A positive correlation (ρ=0.82, p<0.0001) was observed between nephrin and VEGF mRNA expression in preeclamptic women. ROC curve analyses demonstrated a strong ability of this method to discriminate between the different study groups. qPCR analysis of podocyte-specific molecules in urine samples is a rapid and reliable method to quantify podocyturia. We demonstrate that this method distinguishes preeclamptic patients from healthy controls at disease onset. This method may be a tool for the detection of preeclampsia at an earlier stage, thereby preventing maternal and fetal morbidity and mortality.

Mass spectrometry as a novel method for detection of podocyturia in pre-eclampsia

Podocyturia, i.e. urinary loss of viable podocytes, may serve as a diagnostic tool for pre-eclampsia and as a marker of active renal disease. The current method to detect podocyturia is technically complex, lengthy and requires a high level of expertise for interpretation. The aim of this study was to develop a new technique for the identification of urinary podocytes, based on the detection of podocyte-specific tryptic peptides by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS), which will provide an operator-independent and highly reproducible method. The diagnosis of pre-eclampsia was confirmed in the presence of hypertension (>140/90 mmHg) and proteinuria >0.3 g/24 h urine. The diagnosis of HELLP was confirmed based on the accepted clinical criteria of hemolysis, elevated liver enzymes and low platelet count. Random urine samples within 24 h prior to delivery were collected and centrifuged. One half of the sediment was cultured for 24 h to select for viable cells and then stained with a podocin antibody, followed by a secondary fluorescein isothiocyanate-labeled antibody to identify podocytes. The second half of the pellet was solubilized, digested and analyzed by LC-MS/MS using an internal standard. We have recruited 13 patients with pre-eclampsia and 6 patients with pre-eclampsia/HELLP syndrome. The presence of podocytes was confirmed in all patients by the podocyte culture method. In the respective samples, the presence of a podocin-specific tryptic peptide was confirmed with LC-MS/MS technology. The LC-MS/MS method is a reliable technology for the identification of urinary podocytes, based on the presence of podocyte-specific proteins in the urine.

786: Use of random protein to creatinine ratio as a diagnostic tool in preeclampsia

786: Use of random protein to creatinine ratio as a diagnostic tool in preeclampsia

GRP78 as a marker of pre-eclampsia: an exploratory study

Although the exact mechanisms that lead to shallow invasion or defective trophoblastic differentiation in pre-eclampsia are still unknown, it is widely admitted that the etiology of pre-eclampsia is a defect in trophoblast invasion of the uterine spiral arteries. We have previously observed that the status of a chaperone protein, glucose regulated protein 78 (GRP78) is associated with the invasive properties of cytotrophoblastic cells; we therefore hypothesized that circulating GRP78 could serve as a diagnostic tool in pre-eclampsia. In a prospective case-control study, we quantified GRP78 autoantibodies, complexes of GRP78 with autoantibodies and GRP78 (C-term fragment, N-term fragment and full-length GRP78) by ELISA. Plasma from women diagnosed with pre-eclampsia (n = 16), from women during the first trimester of pregnancy who subsequently developed pre-eclampsia (n = 10) and from healthy pregnant women (controls, n = 58 at term, n = 26 at first trimester) were analysed and compared. We observed no significant difference between pre-eclamptic and healthy pregnant women for autoantibodies-GRP78 complexes or total GRP78 at both first trimester and at delivery. In contrast, the ratio of C-terminal GRP78 over full length GRP78 was significantly different in plasma of pre-eclamptic patients as compared with controls both during first trimester (P < 0.004) and at term (P < 0.0001). Our findings suggest that circulating C-terminal GRP78 reflect the invasive properties of cells, and could be used as a predictive marker for pre-eclampsia early in pregnancy.

821: Brain-type natriuretic peptide (BNP) as a diagnostic tool in preeclampsia

821: Brain-type natriuretic peptide (BNP) as a diagnostic tool in preeclampsia

Evaluation of B-type natriuretic peptide (BNP) levels in normal and preeclamptic women

B-type natriuretic peptide (BNP) is synthesized in cardiac ventricles in response to volume expansion. This study evaluated BNP levels to determine trends during pregnancy, and to assess BNP as a diagnostic tool in preeclampsia. We studied 163 BNP levels in 118 pregnant women, ranging from first trimester to term. An additional 34 patients with preeclampsia were studied and compared to 25 normal control patients at term. Plasma BNP values were determined using a standard assay. The median BNP levels during the 1st, 2nd, 3rd trimester, and at term were equivalent (18.4, 17.9, 15.5, and 17.8 pg/mL, respectively, P = .796). The median BNP levels in normal patients, mild preeclamptics, and severe preeclamptics were 17.8, 21.1, and 101 pg/mL, respectively, with the severe group being significantly higher than the mild group (P = .003) and any phase of normal pregnancy (P < .001 in each case). A BNP cut-off of <40.6 pg/mL had a negative predictive value of 92% in excluding preeclampsia. In normal pregnancies, median BNP values are <20 pg/mL, and stable throughout gestation. In severe preeclampsia BNP levels are elevated. This may reflect ventricular stress and/or subclinical cardiac dysfunction associated with preeclampsia.

Elevated plasma endothelial microparticles: Preeclampsia versus gestational hypertension

Elevated plasma endothelial microparticle levels have been found to be elevated in women with preeclampsia. However, their role in distinguishing preeclampsia from gestational hypertension remains to be elucidated. The objectives of this study were to compare endothelial microparticle levels among patients with preeclampsia, gestational hypertension, and healthy pregnant control subjects and to evaluate the effect of plasma from women with preeclampsia and gestational hypertension on the release of endothelial microparticles by renal microvascular endothelial cells. A prospective study was conducted on 52 women with preeclampsia, 20 women with gestational hypertension, and 38 healthy pregnant control subjects. Endothelial microparticles were measured by flow cytometry with fluorescent monoclonal mouse anti-human antibodies against CD31, CD42b, and CD62E. CD31 + /42b - endothelial microparticle levels were 10497 +/- 5145 counts/microL in women with preeclampsia versus 6768 +/- 1810 counts/microL in women with gestational hypertension ( P < .01). In control subjects, CD31 + /42b - endothelial microparticle levels were 6119 +/- 3592 counts/microL. CD62E + endothelial microparticle levels were 1930 +/- 966 counts/microL in women with preeclampsia versus 822 +/- 150 counts/microL in women with gestational hypertension ( P <.01). In control subjects, CD62E + endothelial microparticle levels were 712 +/- 160 counts/microL. Incubation of renal microvascular endothelial cells with plasma from women with preeclampsia resulted in a rise in CD31 + and CD62E + endothelial microparticle levels as compared with women with gestational hypertension and control subjects. Endothelial microparticle levels are higher in women with preeclampsia than in women with gestational hypertension and control subjects. The measurement of endothelial microparticles may be useful as a diagnostic tool for preeclampsia in pregnant women.