From the Department of Obstetrics (L.A.D., N.S., L.F., W.H., S.V.), Charité - Universitätsmedizin, Berlin, Germany.
Department of Laboratory Medicine, Clinical Chemistry, and Pathobiochemistry (F.H.P.), Charité - Universitätsmedizin, Berlin, Germany.
Hypertension. 2021 Feb;77(2):461-471. doi: 10.1161/HYPERTENSIONAHA.120.15146. Epub 2020 Dec 7.
This retrospective real-world study investigated the clinical use of the sFlt-1 (soluble fms-like tyrosine kinase 1)/PlGF (placental growth factor) ratio alone or in combination with other clinical tests to predict an adverse maternal (maternal death, kidney failure, hemolysis elevated liver enzymes low platelets-syndrome, pulmonary edema, disseminated intravascular coagulation, cerebral hemorrhage, or eclampsia) or fetal (delivery before 34 weeks because of preeclampsia and/or intrauterine growth restriction, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, placental abruption or intrauterine fetal death or neonatal death within 7 days post natum) pregnancy outcome in patients with signs and symptoms of preeclampsia. We evaluated the sFlt-1/PlGF-ratio cutoff values of 38 and 85 and evaluated its integration into a multimarker model. Of 1117 subjects, 322 (28.8%) developed an adverse fetal or maternal outcome. Patients with an adverse versus no adverse outcome had a median sFlt-1/PlGF-ratio of 177 (interquartile range, 54-362) versus 14 (4-64). Risk-stratification with the sFlt-1/PlGF cutoff values into high- (>85), intermediate- (38-85), and low-risk (<38) showed a significantly shorter time to delivery in high- and intermediate- versus low-risk patients (4 versus 8 versus 29 days). When integrating all available clinical information into a multimarker model, an area under the curve of 88.7% corresponding to a sensitivity, specificity, positive and negative predictive value of 80.0%, 87.3%, 75.0%, and 90.2% was reached. The sFlt-1/PlGF-ratio alone was inferior to the full model with an area under the curve of 85.7%. As expected, blood pressure and proteinuria were significantly less accurate with an area under the curve of 69.0%. Combining biomarker measurements with all available information in a multimarker modeling approach increased detection of adverse outcomes in women with suspected disease.
这项回顾性真实世界研究调查了 sFlt-1（可溶性 fms 样酪氨酸激酶 1）/PlGF（胎盘生长因子）比值单独或与其他临床检测联合用于预测不良母体（产妇死亡、肾衰竭、溶血升高肝酶低血小板综合征、肺水肿、弥漫性血管内凝血、脑出血或子痫）或胎儿（因子痫前期和/或宫内生长受限而在 34 周前分娩、呼吸窘迫综合征、坏死性小肠结肠炎、脑室出血、胎盘早剥或宫内胎儿死亡或新生儿出生后 7 天内死亡）妊娠结局的临床应用。我们评估了 sFlt-1/PlGF-比值截断值为 38 和 85，并评估了其纳入多标志物模型的情况。在 1117 例患者中，有 322 例（28.8%）发生不良胎儿或母体结局。与无不良结局相比，有不良结局的患者 sFlt-1/PlGF-比值中位数为 177（四分位距，54-362）比 14（4-64）。根据 sFlt-1/PlGF 截断值将风险分层为高（>85）、中（38-85）和低（<38）风险组，高风险和中风险患者的分娩时间明显短于低风险患者（4 天比 8 天比 29 天）。当将所有可用的临床信息整合到多标志物模型中时，曲线下面积为 88.7%，对应的敏感性、特异性、阳性和阴性预测值分别为 80.0%、87.3%、75.0%和 90.2%。sFlt-1/PlGF-比值单独使用时的曲线下面积为 85.7%，劣于全模型。正如预期的那样，血压和蛋白尿的曲线下面积分别为 69.0%，准确性明显较低。将生物标志物测量值与多标志物建模方法中所有可用信息相结合，增加了对疑似疾病女性不良结局的检测。
