New indicators of known markers in the early prediction of preeclampsia progression

Background: Preeclampsia is a multisystem complication affecting 2%–8% of pregnant women and makes a significant contribution to maternal and perinatal morbidity and mortality. Aim: To determine the predictive value levels of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and the sFlt-1/PlGF ratio in forecasting the progression of preeclampsia severity within two weeks. Methods: A prospective cohort study was conducted. It included 64 patients with singleton pregnancies complicated by elevated blood pressure (140/90 mmHg) and/or proteinuria, who were admitted to City Clinical Hospital named after S.S. Yudin (Moscow) at 22–38 weeks of gestation. Venous blood samples were collected at admission to determine sFlt-1 and PlGF concentrations and the sFlt-1/PlGF ratio. Based on the clinical course and pregnancy outcome, patients were divided into two groups: group 1, 30 (54.5%) women with preeclampsia who experienced maternal deterioration and/or fetal compromise requiring early delivery; group 2, 25 (45.5%) women with stable preeclampsia whose pregnancies were successfully prolonged to term under treatment in accordance with clinical guidelines. Group 1 was further divided into two subgroups according to delivery timing: subgroup 1a, women who delivered within two weeks; subgroup 1b, women who delivered after more than two weeks. Results: The analysis showed statistically significant differences between the groups (p 0.01 and p = 0.011 in sFlt-1 levels and the sFlt-1/PlGF ratio, respectively), whereas no statistically significant differences were found in PlGF levels (p = 0.076). Threshold values for sFlt-1 and the sFlt-1/PlGF ratio indicating high risk of preeclampsia that required early delivery were 30,297 pg/mL and 3030, respectively. In the next stage, threshold values predicting preeclampsia progression within two weeks were determined as 23,497.0 pg/mL for sFlt-1 and 977.7 for the sFlt-1/PlGF ratio. Conclusion: This study established threshold values of sFlt-1 and the sFlt-1/PlGF ratio, indicating a high risk of preeclampsia in patients with initial nonspecific symptoms. In addition, threshold values were identified that indicate a high probability of progression to severe preeclampsia requiring delivery within two weeks.