Am J Perinatol 2021; 38(S 01): e292-e298
DOI: 10.1055/s-0040-1709696
Original Article

Evaluation of the Prognostic Value of the sFlt-1/PlGF Ratio in Early-Onset Preeclampsia

Oriane Tasta
1  Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France
,
Olivier Parant
1  Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France
,
Safouane M. Hamdi
2  Department of Biochemistry and Hormonology, Paul Sabatier University, Toulouse, France
,
Mickael Allouche
1  Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France
,
Christophe Vayssiere
1  Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France
,
1  Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France
3  INSERM UMR 1048 I2MC, Université de Toulouse III, Toulouse, France
› Author Affiliations
Funding None.

Abstract

Objective Increased expression of soluble fms-like tyrosine kinase 1 (sFlt-1), associated with a decrease in placental growth factor (PlGF), plays a key role in the pathogenesis of preeclampsia (PE). We evaluated the prognostic value of the sFlt-1/PlGF ratio for the onset of adverse maternofetal outcomes (AMFO) in case of early-onset PE with attempted expectant management.

Study Design From October 2016 through November 2018, all singleton pregnancies complicated by early-onset PE (before 34 weeks of gestation) were included in a cohort study. The plasma levels of sFlt-1 and PlGF were blindly measured on admission. For the statistical analysis, we performed a bivariate analysis, a comparison of the receiving operating characteristic curves and a survival analysis estimated by the Kaplan–Meier method.

Results Among 109 early PE, AMFO occurred in 87 pregnancies (79.8%), mainly hemolysis, elevated liver enzymes, and low platelet count syndrome and severe fetal heart rate abnormalities requiring urgent delivery. The area under the curve (AUC) of sFlt-1/PlGF ratio was 0.82 (95% confidence interval [CI]: 0.73–0.88) for the risk of AMFO and the difference between the AUCs was significant for each separate standard parameter (p = 0.018 for initial diastolic blood pressure, p = 0.013 for alanine aminotransferase, p < 0.001 for uric acid). Pregnancies were best classified by a cutoff ratio of 293, with a sensitivity of 95% and a specificity of 50%. With a ratio value less than 293, no pregnancy was complicated or had been stopped during the first 5 days. A ratio more than 293 was associated with an increased risk of AMFO onset (hazard ratio [HR]: 3.61; 95% CI: 2.13–6.10; p < 0.001) and had a significant association with the length of time between the diagnosis of PE and delivery (HR: 2.49; 95% CI: 1.56–3.96; p < 0.001).

Conclusion The sFlt-1/PlGF ratio is an additional tool in the prediction of AMFO in proven early-onset PE, which is likely to improve care by anticipating severe complications.

Key Points

  • The sFlt-1/PlGF ratio is associated with AMFO.

  • It is an additional tool for physician.

  • We proposed a 293 cutoff value for the ratio.



Publication History

Received: 20 January 2020

Accepted: 15 March 2020

Publication Date:
23 May 2020 (online)

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