EP17.17: Plasma sFlt‐1/PlGF ratio as multiples of the median predicts pre‐eclampsia with severe features within two weeks

To compare multiples of the median (MoM) of maternal plasma sFlt-1/PlGF ratio, sFlt-1, PlGF, and conventional clinical and laboratory values to predict pre-eclampsia with severe features (PSF) within two weeks. Secondary data analysis of a study across 18 US centres involving hospitalised hypertensive individuals between 23-35 weeks of gestation. ROC curve analyses of maternal plasma biomarkers, highest systolic or diastolic blood pressures, and laboratory values at enrolment were performed for the prediction of PSF. Their areas under the curve (AUC) were compared, and quasi-Poisson regression models were fitted to estimate relative risks. The primary outcome was PSF within two weeks. Secondary outcomes were a composite of severe adverse maternal outcomes (HELLP syndrome, placental abruption, eclampsia, DIC, and pulmonary edema), and a composite of severe adverse neonatal outcomes (birthweight <3rd percentile, very preterm birth [<32 weeks] and fetal/neonatal death) within two weeks. PSF within two weeks was observed in 33.2% (180/543). A cut-off of ≥ 11.5 MoM for sFlt-1/PlGF plasma ratio was used to compare cases and controls (< cut-off). PSF within two weeks (66.0% vs. 5.7%; <0.001), and composites of severe adverse maternal (8.11% vs. 2.7%; p = 0.006) or perinatal outcomes (41.3% vs. 10.14%; p = 0.001) were more frequent in cases than controls. This cut-off was independently associated with PSF (adjusted incidence rate ratio [aIRR]: 9.08, 95% CI: 6.11 to 14.06; p < 0.001) and a composite of severe adverse perinatal outcomes (aIRR: 9.42, 95% CI: 6.36 to 14.53; p < 0.001), but not with a composite of severe adverse maternal outcomes (p = 0.08). The AUC of sFlt-1/PlGF plasma ratio in MoM for PSF within two weeks was significantly higher (p < 0.001 for all comparisons) than either plasma biomarker alone or any other parameter. sFlt-1/PlGF plasma ratio ≥11.5 MoM among hospitalised, hypertensive patients between 23-35 weeks of gestation predicts progression to PSF and severe adverse perinatal outcomes within two weeks.

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Publication Details

Journal
Ultrasound in Obstetrics and Gynecology
Published
2024-09-01
DOI
https://doi.org/10.1002/uog.28674
Primary Topic
Pregnancy and preeclampsia studies
Type
article
Field-Weighted Citation Impact
0.00

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article

EP17.17: Plasma sFlt‐1/PlGF ratio as multiples of the median predicts pre‐eclampsia with severe features within two weeks

Yvonne Gollin, Judette Louis, KA Boggess, M. Costantine et al.
Ultrasound in Obstetrics and Gynecology
Pregnancy and preeclampsia studies
article

EP17.17: Plasma sFlt‐1/PlGF ratio as multiples of the median predicts pre‐eclampsia with severe features within two weeks

Yvonne Gollin, Judette Louis, KA Boggess, M. Costantine, Britta Panda, S. Ananth Karumanchi, Sarosh Rana, Irina Burd, Tiffany A. Moore Simas, Danielle Durie, Sarah J. Kilpatrick, Ravi Thadhani, Vinícius F. Calsavara, Elizabeth Lemoine, Samantha Wiegand, Robert M. Silver, Beth A. Plunkett, Rachel K. Scott, Jimmy Espinoza, Errol R. Norwitz, Amy Murtha, Stephanie L. Gaw, Dhiraj Kumar Singh
article en

Abstract

To compare multiples of the median (MoM) of maternal plasma sFlt-1/PlGF ratio, sFlt-1, PlGF, and conventional clinical and laboratory values to predict pre-eclampsia with severe features (PSF) within two weeks. Secondary data analysis of a study across 18 US centres involving hospitalised hypertensive individuals between 23-35 weeks of gestation. ROC curve analyses of maternal plasma biomarkers, highest systolic or diastolic blood pressures, and laboratory values at enrolment were performed for the prediction of PSF. Their areas under the curve (AUC) were compared, and quasi-Poisson regression models were fitted to estimate relative risks. The primary outcome was PSF within two weeks. Secondary outcomes were a composite of severe adverse maternal outcomes (HELLP syndrome, placental abruption, eclampsia, DIC, and pulmonary edema), and a composite of severe adverse neonatal outcomes (birthweight <3rd percentile, very preterm birth [<32 weeks] and fetal/neonatal death) within two weeks. PSF within two weeks was observed in 33.2% (180/543). A cut-off of ≥ 11.5 MoM for sFlt-1/PlGF plasma ratio was used to compare cases and controls (< cut-off). PSF within two weeks (66.0% vs. 5.7%; <0.001), and composites of severe adverse maternal (8.11% vs. 2.7%; p = 0.006) or perinatal outcomes (41.3% vs. 10.14%; p = 0.001) were more frequent in cases than controls. This cut-off was independently associated with PSF (adjusted incidence rate ratio [aIRR]: 9.08, 95% CI: 6.11 to 14.06; p < 0.001) and a composite of severe adverse perinatal outcomes (aIRR: 9.42, 95% CI: 6.36 to 14.53; p < 0.001), but not with a composite of severe adverse maternal outcomes (p = 0.08). The AUC of sFlt-1/PlGF plasma ratio in MoM for PSF within two weeks was significantly higher (p < 0.001 for all comparisons) than either plasma biomarker alone or any other parameter. sFlt-1/PlGF plasma ratio ≥11.5 MoM among hospitalised, hypertensive patients between 23-35 weeks of gestation predicts progression to PSF and severe adverse perinatal outcomes within two weeks.

Ultrasound in Obstetrics and GynecologyVol. 64(S1)
University of North Carolina at Chapel Hill (US), Cedars-Sinai Medical Center (US), Tufts Medical Center (US), UMass Memorial Health Care (US), Lehigh Valley Hospital-Pocono (US), Torrance Memorial Medical Center (US), NorthShore University HealthSystem (US), Johns Hopkins University (US), Emory University (US), University of North Carolina Wilmington (US), University of California, San Francisco (US), University of South Florida (US), Johns Hopkins Medicine (US), Newton Wellesley Hospital (US), Miami Valley Hospital (US), The Ohio State University Wexner Medical Center (US), University of Utah Hospital (US), University of Chicago Medical Center (US), Lehigh Valley Health Network (US), Sharp Mary Birch Hospital for Women & Newborns (US), Johns Hopkins Hospital (US), UMass Memorial Medical Center (US), MedStar Health (US), The University of Texas Health Science Center at Houston (US)
Ohio State University, Emory University, Tufts Medical Center, Johns Hopkins University, University of South Florida, MedStar Health Research Institute, NorthShore University HealthSystem, Cedars-Sinai Medical Center, University of North Carolina Wilmington, University of North Carolina at Chapel Hill
Openalex Percentile: Top 76%
Pregnancy and preeclampsia studies
DOIOpen Access PDFOpenAlex
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