The Sflt-1/Plgf Ratio as a Diagnostic Biomarker for Preeclampsia: A Systematic Review

Abstract : Background: Preeclampsia (PE) is a medical condition associated with placental and maternal endothelial dysfunction that can lead to complications and long-term health problems affecting both the mother and the child. Previous studies have shown that the ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) has potential in the diagnosis of PE. Objective: This systematic review aims to determine the role of the sFlt-1/PlGF ratio as a diagnostic biomarker in preeclampsia. Methods: This systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed using three electronic databases, namely PubMed, ScienceDirect, and Cochrane, up to February 2026. The inclusion criteria included studies analyzing the sFlt-1/PlGF ratio in pregnant women with singleton pregnancies. This review analyzed the cut-off values, area under the curve (AUC), sensitivity, and specificity. Results: Four studies were included in this review, which consist of two case-control studies and two prospective cohort studies. The reported cut-off values for the sFlt-1/PlGF ratio varied across studies, including <33, <38, and ≥85. All studies demonstrated good diagnostic performance with AUC values ranging from 0.80 to 0.94. The reported sensitivity and specificity were also relatively high in detecting the occurrence of preeclampsia in pregnant women. Conclusion: The sFlt-1/PlGF ratio is a potential biomarker that can improve the diagnostic accuracy of PE in pregnant women. The use of the sFlt-1/PlGF ratio may support patient condition identification and facilitate earlier clinical decision-making in the management of pregnancies at risk of PE.