Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
DynaLIFE Medical Labs, Edmonton, AB, Canada.
J Appl Lab Med. 2023 May 4;8(3):457-468. doi: 10.1093/jalm/jfad003.
Preeclampsia is a multisystem disorder defined by new onset of hypertension with proteinuria after 20 weeks gestation. In part due to dysregulation of pro-angiogenic factors (e.g., placental growth factor [PlGF]) and anti-angiogenic factors (e.g., soluble fms-like tyrosine kinase 1 [sFlt-1]), preeclampsia results in decreased placental perfusion. An increased sFlt-1:PlGF ratio is associated with increased risk of preeclampsia. In this study, we evaluated sFlt-1:PlGF cutoffs and evaluated the clinical performance of sFlt-1:PlGF for predicting preeclampsia.
sFlt-1:PlGF results from 130 pregnant females with clinical suspicion of preeclampsia were used to evaluate the diagnostic accuracy of different sFlt-1:PlGF cutoffs and to compare the clinical performance of sFlt-1:PlGF to traditional preeclampsia markers (proteinuria and hypertension). Serum sFlt-1 and PlGF were measured using Elecsys immunoassays (Roche Diagnostics) and preeclampsia diagnosis was verified by expert chart review.
A sFlt-1:PlGF cutoff of >38 yielded the greatest diagnostic accuracy of 90.8% (95% CI, 85.8%-95.7%). Using a cutoff of >38, sFlt-1:PlGF exhibited a greater diagnostic accuracy than traditionally used parameters such as new or worsening proteinuria or hypertension (71.9% and 68.6%, respectively). sFlt-1:PlGF >38 exhibited a negative predictive value (NPV) of 96.4% for rule-out of preeclampsia within 7 days, and a positive predictive value (PPV) of 84.8% for predicting preeclampsia within 28 days.
Our study shows the superior clinical performance of sFlt-1:PlGF over hypertension and proteinuria alone to predict preeclampsia at a high-risk obstetrical unit.
子痫前期是一种多系统疾病，其特征为妊娠 20 周后新出现高血压伴蛋白尿。部分原因是促血管生成因子（如胎盘生长因子 [PlGF]）和抗血管生成因子（如可溶性 fms 样酪氨酸激酶 1 [sFlt-1]）失调，导致胎盘灌注减少。sFlt-1:PlGF 比值升高与子痫前期风险增加相关。本研究评估了 sFlt-1:PlGF 截止值，并评估了 sFlt-1:PlGF 预测子痫前期的临床性能。
使用 130 例临床疑似子痫前期孕妇的 sFlt-1:PlGF 结果，评估不同 sFlt-1:PlGF 截止值的诊断准确性，并比较 sFlt-1:PlGF 与传统子痫前期标志物（蛋白尿和高血压）的临床性能。使用 Elecsys 免疫测定法（罗氏诊断公司）测量血清 sFlt-1 和 PlGF，通过专家图表审查验证子痫前期诊断。
sFlt-1:PlGF 截止值>38 时，诊断准确性最高，为 90.8%（95%CI，85.8%-95.7%）。使用截止值>38 时，sFlt-1:PlGF 的诊断准确性优于传统参数，如新出现或恶化的蛋白尿或高血压（分别为 71.9%和 68.6%）。sFlt-1:PlGF >38 时，7 天内排除子痫前期的阴性预测值（NPV）为 96.4%，28 天内预测子痫前期的阳性预测值（PPV）为 84.8%。
本研究表明，在高危产科单位，sFlt-1:PlGF 预测子痫前期的临床性能优于单纯高血压和蛋白尿。
