Department of Obstetrics and Gynecology, Hospital-Residència Sant Camil Consorci Sanitari de l'Alt Penedès-Garraf, Barcelona, Spain.
Clinical Biochemistry and Laboratory Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain.
Fetal Diagn Ther. 2021;48(7):517-525. doi: 10.1159/000517391. Epub 2021 Aug 12.
Short-term prediction of pre-eclampsia (PE) using soluble FMS-like tyrosine kinase-1 (sFlt-1)/ placental growth factor (PlGF) ratio has high false-positive rate. Therefore, we developed a prognostic prediction tool that predicts early-onset PE leading to delivery within 1 week on pregnancies with an sFlt-1/PlGF ratio above 38 and compared it with an analogous model based on sFlt-1/PlGF ratio and with the 655 sFlt-1/PlGF ratio cutoff.
Cohort study of 363 singleton pregnancies with clinical suspicion of PE before 34 weeks of gestation, allowing repeated assessments (522). 213 samples with an sFlt-1/PlGF ratio above 38 were assessed to construct and identify the best-fit linear mixed model. N-terminal pro-B-type natriuretic peptide (NT-proBNP), sFlt-1 MoM, PlGF MoM, and sFlt-1/PlGF ratio combined with gestational age (GA) were assessed.
None of the pregnancies with an sFlt-1/PlGF ratio of 38 or below developed early-onset PE (309 samples from 240 pregnancies). Conversely, 47 women of 213 assessments (22.1%) with an sFlt-1/PlGF ratio above 38 developed the assessed outcome. The selected model included sFlt-1 MoM, NT-proBNP, and GA. Differences in area under the curve were observed between the selected model and the GA + sFlt-1/PlGF model (p = 0.04). At an sFlt-1/PlGF ratio cutoff of 655, detection rate was 31.9% (15/47), while the selected model detection was 55.3% (26/47) (p = 0.008).
Considering repeated assessments, the sFlt-1/PlGF ratio of 38 or below adequately ruled out early-onset PE, leading to delivery within 1 week. However, when sFlt-1/PlGF ratio is above 38, the prediction tool derived from linear mixed model based on GA, NT-proBNP, and sFlt-1 MoM, provided a better prognosis prediction than the sFlt-1/PlGF ratio.
使用可溶性 FMS 样酪氨酸激酶-1（sFlt-1）/胎盘生长因子（PlGF）比值预测子痫前期（PE）的短期结果具有较高的假阳性率。因此，我们开发了一种预测工具，可以预测在 sFlt-1/PlGF 比值高于 38 的情况下，1 周内发生的早发型 PE 并进行分娩，并将其与基于 sFlt-1/PlGF 比值的类似模型进行了比较，并与 655 sFlt-1/PlGF 比值的截止值进行了比较。
对 363 例怀疑在 34 周前发生子痫前期的单胎妊娠进行队列研究，允许重复评估（522 例）。评估了 213 例 sFlt-1/PlGF 比值高于 38 的样本，以构建和识别最佳拟合线性混合模型。评估了 N 端脑钠肽前体（NT-proBNP）、sFlt-1 MoM、PlGF MoM 和 sFlt-1/PlGF 比值与孕龄（GA）的关系。
在 sFlt-1/PlGF 比值为 38 或更低的妊娠中，均未发生早发型 PE（240 例妊娠中的 309 例）。相反，在 213 次评估中有 47 名妇女（22.1%）的 sFlt-1/PlGF 比值高于 38，发生了评估的结局。所选模型包括 sFlt-1 MoM、NT-proBNP 和 GA。所选模型与 GA+sFlt-1/PlGF 模型之间的曲线下面积差异有统计学意义（p=0.04）。在 sFlt-1/PlGF 比值为 655 的截止值时，检测率为 31.9%（15/47），而所选模型的检测率为 55.3%（26/47）（p=0.008）。
考虑到重复评估，sFlt-1/PlGF 比值为 38 或更低可充分排除早发型 PE，导致 1 周内分娩。然而，当 sFlt-1/PlGF 比值高于 38 时，基于 GA、NT-proBNP 和 sFlt-1 MoM 的线性混合模型衍生的预测工具比 sFlt-1/PlGF 比值提供了更好的预后预测。
