title: Diagnostic accuracy of insulin-like growth factor binding protein-1 for amniotic fluid embolism*.
abstract: OBJECTIVE
  To test whether serum insulin-like growth factor binding protein-1 could be used as a biomarker of amniotic fluid passage into the maternal circulation.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Thirteen centers in France.
  
  
  METHODS
  This case-control study included a group with amniotic fluid embolism (the amniotic fluid embolism group) and a group with symptoms unrelated to amniotic fluid embolism (the non-amniotic fluid embolism group). Serum insulin-like growth factor binding protein-1 level was measured within 6 hrs from onset of symptoms. We also determined serum insulin-like growth factor binding protein-1 in four additional groups of patients with 1) postpartum hemorrhage, 2) uncomplicated labor, 3) normal pregnancy, and 4) non-pregnant patients with acute pulmonary embolism.
  
  
  METHODS
  None.
  
  
  METHODS
  Serum insulin-like growth factor binding protein-1 levels were determined using an immuno-enzymatic assay.
  
  
  RESULTS
  The amniotic fluid embolism group included 25 patients, the non-amniotic fluid embolism group had 20 patients, the postpartum hemorrhage group had 24 patients, and the uncomplicated labor group had 50 patients. The serum levels of insulin-like growth factor binding protein-1 were higher in the amniotic fluid embolism group (234 134-635 µmol/L) compared with the non-amniotic fluid embolism, postpartum hemorrhage, and uncomplicated labor groups, which had serum levels of 56 36-91 µmol/L, 65 39-91 µmol/L and 49 30-78 µmol/L, respectively (p < .001). Serum insulin-like growth factor binding protein-1 level was not different in women during normal pregnancy (57 37-85 µg/L) compared to the uncomplicated labor group. Patients with acute pulmonary embolism had the lowest insulin-like growth factor binding protein-1 level (5 2-14 µg/L). The area under the receiver-operating-characteristic curve for serum insulin-like growth factor binding protein-1 was 0.98 0.97-1.00 for the amniotic fluid embolism diagnostic. Insulin-like growth factor binding protein-1 rose from 56 43-90 µg/L before symptoms to 458 161-1514 µg/L after the onset of symptoms in ten patients with available measurements of baseline serum insulin-like growth factor binding protein-1.
  
  
  CONCLUSIONS
  Increased serum levels of insulin-like growth factor binding protein-1 appear to be a valuable biomarker of amniotic fluid passage into the maternal circulation and may be used to diagnose amniotic fluid embolism.
authors.affiliation: Department of Anesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique- Hôpitaux de Paris, EA-3509 University of Paris 7 Denis Diderot, Paris, France. matthieu.m.legrand@gmail.com
authors.forename: Matthieu
authors.initials: M
authors.lastname: Legrand
authors.forename: Mathias
authors.initials: M
authors.lastname: Rossignol
authors.forename: Sophie
authors.initials: S
authors.lastname: Dreux
authors.forename: Dominique
authors.initials: D
authors.lastname: Luton
authors.forename: Chloé
authors.initials: C
authors.lastname: Ventré
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Barranger
authors.forename: Said
authors.initials: S
authors.lastname: Laribi
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
authors.forename: Françoise
authors.initials: F
authors.lastname: Muller
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D004619:Embolism, Amniotic Fluid / Q000175:diagnosis*; D005260:Female; D006801:Humans; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000097:blood*; D007743:Labor, Obstetric / Q000097:blood; D006473:Postpartum Hemorrhage / Q000097:blood; D011247:Pregnancy / Q000097:blood
chemical_list: D015415:Biomarkers; D018970:Insulin-Like Growth Factor Binding Protein 1