Department of Women and Children's Health, School of Life Course Sciences, King's College London, UK.
Department of Women and Children's Health, School of Life Course Sciences, King's College London, UK.
Pregnancy Hypertens. 2021 Jun;24:90-95. doi: 10.1016/j.preghy.2021.02.012. Epub 2021 Mar 3.
To assess the diagnostic performance of angiogenic biomarkers in determining need for delivery in seven days in women with late preterm preeclampsia.
In a prospective observational cohort study in 36 maternity units across England and Wales, we studied the diagnostic accuracy of placental growth factor (PlGF) and sFlt-1 in determining the risk of complications requiring delivery in late preterm (34 to 36 weeks' gestation) preeclampsia. Angiogenic biomarkers were measured using the Quidel (PlGF) and Roche (sFlt-1:PlGF ratio) assays. Additional clinical data was obtained for use within the established 'Prediction of complications in early-onset pre-eclampsia' (PREP)-S prognostic model. Biomarkers were assessed using standard methods (sensitivity, specificity, Receiver Operator Curve areas). Estimated probability of early delivery from PREP-S was compared to actual event rates.
Clinically indicated need for delivery for pre-eclampsia within seven days.
PlGF (Quidel) testing had high sensitivity (97.9%) for delivery within seven days, but negative predictive value was only 71.4%, with low specificity (8.4%), with similar results from sFlt-1/PlGF assay. The area under the curve for PlGF was 0.60 (SE 0.03), and 0.65 (0.03), and 0.64 (0.03) for PREP-S in combination with PlGF, and sFlt-1:PlGF, respectively.
Angiogenic biomarkers do not add to clinical assessment to help determine need for delivery for women with late preterm pre-eclampsia. Existing models developed in women with early-onset pre-eclampsia to predict complications cannot be used to predict clinically indicated need for delivery in women with late preterm pre-eclampsia.
评估血管生成生物标志物在确定晚期早产儿子痫前期患者七天内分娩需求的诊断性能。
在英格兰和威尔士的 36 家产科单位进行的前瞻性观察队列研究中，我们研究了胎盘生长因子（PlGF）和 sFlt-1 确定晚期早产儿（34-36 周妊娠）子痫前期并发症分娩需求风险的诊断准确性。血管生成生物标志物使用 Quidel（PlGF）和 Roche（sFlt-1:PlGF 比值）测定法进行测量。为了在既定的“早期发作子痫前期并发症预测”（PREP）-S 预后模型中使用，还获得了其他临床数据。使用标准方法评估生物标志物（灵敏度、特异性、接收器工作特性曲线面积）。将 PREP-S 预测的早期分娩概率与实际事件发生率进行比较。
子痫前期在七天内需要临床指示分娩。
PlGF（Quidel）检测对于七天内分娩具有很高的灵敏度（97.9%），但阴性预测值仅为 71.4%，特异性低（8.4%），sFlt-1/PlGF 测定也有类似结果。PlGF 的曲线下面积为 0.60（SE 0.03），PREP-S 结合 PlGF 和 sFlt-1:PlGF 的曲线下面积分别为 0.65（0.03）和 0.64（0.03）。
血管生成生物标志物不能增加临床评估，以帮助确定晚期早产儿子痫前期患者的分娩需求。为预测早期发作子痫前期的并发症而开发的现有模型不能用于预测晚期早产儿子痫前期患者的临床指征性分娩需求。
