Langeza Saleh1, Koen Verdonk2, A H Jan Danser3, Eric A P Steegers4, Henk Russcher5, Anton H van den Meiracker2, Willy Visser1. 1. Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, The Netherlands; Department of Obstetrics and Gynecology, The Netherlands. 2. Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, The Netherlands. 3. Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, The Netherlands. Electronic address: a.danser@erasmusmc.nl. 4. Department of Obstetrics and Gynecology, The Netherlands. 5. Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands.
Abstract
OBJECTIVE: To evaluate the additive value of the sFlt-1/PlGF ratio for diagnosing preeclampsia (PE) and predicting prolongation of pregnancy and adverse outcome in a cohort of women with PE or at high risk of PE. STUDY DESIGN: Patients with suspected or confirmed clinical PE were recruited. At time of inclusion blood for measurement of sFlt-1and PlGF was taken. Values were determined after delivery. A cut-off ratio of ≥85 was defined as a positive test. RESULTS: A total of 107 patients were included. Of the patients, 62 (58%) met the clinical criteria of PE at time of blood sampling. In 10% of these patients (n=6) the ratio was <85 (false negative), whereas in 7% (n=3) of patients without clinical PE the ratio was ≥85 (false positive), resulting in positive and negative predictive values of 95% and 88% respectively. One patient with false positive ratio developed superimposed PE and 2 developed gestational hypertension, and adverse outcome occurred in all three. An adverse pregnancy outcome was only encountered in 1 of the 6 patients with a false negative ratio. Using a binary regression model with adjustment for gestational age <34 weeks, the adverse outcome risk was 11 times increased on the basis of clinical PE, and 30 times on the basis of an elevated ratio (P=0.036). CONCLUSION: The additive value of an increased ratio for diagnosing PE is limited since most patients with clinical PE also have a positive ratio. However, an elevated ratio is superior to the clinical diagnosis of PE for predicting an adverse pregnancy outcome. Furthermore, irrespective of clinical PE, a low ratio is inversely correlated with prolongation of pregnancy.
OBJECTIVE: To evaluate the additive value of the sFlt-1/PlGF ratio for diagnosing preeclampsia (PE) and predicting prolongation of pregnancy and adverse outcome in a cohort of women with PE or at high risk of PE. STUDY DESIGN:Patients with suspected or confirmed clinical PE were recruited. At time of inclusion blood for measurement of sFlt-1and PlGF was taken. Values were determined after delivery. A cut-off ratio of ≥85 was defined as a positive test. RESULTS: A total of 107 patients were included. Of the patients, 62 (58%) met the clinical criteria of PE at time of blood sampling. In 10% of these patients (n=6) the ratio was <85 (false negative), whereas in 7% (n=3) of patients without clinical PE the ratio was ≥85 (false positive), resulting in positive and negative predictive values of 95% and 88% respectively. One patient with false positive ratio developed superimposed PE and 2 developed gestational hypertension, and adverse outcome occurred in all three. An adverse pregnancy outcome was only encountered in 1 of the 6 patients with a false negative ratio. Using a binary regression model with adjustment for gestational age <34 weeks, the adverse outcome risk was 11 times increased on the basis of clinical PE, and 30 times on the basis of an elevated ratio (P=0.036). CONCLUSION: The additive value of an increased ratio for diagnosing PE is limited since most patients with clinical PE also have a positive ratio. However, an elevated ratio is superior to the clinical diagnosis of PE for predicting an adverse pregnancy outcome. Furthermore, irrespective of clinical PE, a low ratio is inversely correlated with prolongation of pregnancy.
Authors: L Saleh; M M Alblas; D Nieboer; R I Neuman; Y Vergouwe; I A Brussé; J J Duvekot; E W Steyerberg; H J Versendaal; A H J Danser; A H VAN DEN Meiracker; K Verdonk; W Visser Journal: Ultrasound Obstet Gynecol Date: 2021-10-06 Impact factor: 7.299
Authors: J Torres-Torres; S Espino-Y-Sosa; L C Poon; J M Solis-Paredes; G Estrada-Gutierrez; A Espejel-Nuñez; A Juarez-Reyes; A Etchegaray-Solana; Y Alfonso-Guillen; L Aguilar-Andrade; J A Hernández-Pacheco; J R Villafan-Bernal; R J Martinez-Portilla Journal: Ultrasound Obstet Gynecol Date: 2021-12-29 Impact factor: 8.678