Should we include sFlt-1 in the Swansea criteria?

Introduction:

Acute fatty liver of pregnancy (AFLP) is a severe disease with clinical and laboratory changes similar to HELLP syndrome. Angiogenic profiling with the use of sFlt-1/PlGF ratio can be helpful to stratify pregnant women with impending preeclampsia. Our aim was to analyze the angiogenic profile of pregnancies complicated by AFLP and HELLP.

Material and methods:

Prospectively collected angiogenic profiles of pregnant women diagnosed with HELLP syndrome with or without preeclampsia (group 1) or AFLP (group 2) from 01/2011 to 03/2018 were compared. To overcome gestational age depended angiogenic behavior, cases (group 2) were matched 1:2 with cases from group 1. Matching criteria was gestational age (± 1 week).

The last angiogenic profile before delivery was used for analysis. Non-parametric tests were used for statistical analysis.

Results:

During the study period, 61 women were included. Of those 55 (90.2%) were diagnosed with HELLP syndrome while 6 (9.8%) pregnancies were complicated by AFLP.

sFlt-1/PlGF ratios were comparable between the two groups (AFLP: 196 ± 196 vs. HELLP: 259 ± 248]; p = 0.89). However, patients with AFLP showed extraordinary high sFlt-1 values, (AFLP: 61660 ± 27623 vs. HELLP: 14545 ± 5386; p < 0.0001) while PlGF differed not significantly (AFLP: 197 ± 148 vs. HELLP 49 ± 172, p = 0.65). ROC analysis showed that a s-Flt-1 value > 25765 yield a sensitivity and specificity of 100%, respectively to detect AFLP.

Conclusion:

Angiogenetic profiling, in particular sFlt-1 may be helpful to diagnose AFLP or to differentiate it from HELLP syndrome. A s-Flt-1 value > 25765 may be an additional parameter within the Swansea criteria to diagnose AFLP.