title: Can detection of late-onset PE at triage by sflt-1 or PlGF be improved by the use of additional biomarkers?
abstract: OBJECTIVE
  Accurate identification of preeclampsia (PE) at triage is essential to reduce maternal and fetal morbidity and mortality. The use of maternal blood based biomarkers may facilitate the clinician's ability to assess high risk pregnancies at triage.
  
  
  METHODS
  A prospective cross-sectional study was performed to investigate the value of soluble fms-like tyrosine kinase-1 (sFlt-1), soluble endoglin (sEng), placental growth factor (PlGF), sP-selectin, cell-free fetal DNA and total cell-free DNA in patients with late-onset PE versus gestational age-matched controls.
  
  
  RESULTS
  The diagnosis of late-onset PE (n = 21) at triage was significantly improved by altered levels of sFlt-1, sEng, PlGF and cffDNA as compared with controls (n = 42). Areas under the receiver operating characteristic curves [AUC, Standard error (SE)] for predicting PE were for marker measurements prior to the first stage of labor as follows: sFlt-1 0.97 (SE 0.02), sEng 0.91 (SE 0.04), PlGF 0.95 (SE 0.04), cell-free fetal DNA (DYS 14) 0.84 (SE 0.06), total cell-free DNA (glyceraldehyde 3-phosphate dehydrogenase) 0.61 (SE 0.07), sP-selectin 0.51 (SE 0.07). The discrimination could be slightly improved by using the slt1-PlGF ratio: 0.98 (SE 0.02).
  
  
  CONCLUSIONS
  The sFlt-1 is a useful tool for the detection of late-onset PE at triage. This can be slightly improved using a sFlt-1/PIGF ratio. The addition of other biomarkers did not improve screening performance for late-onset PE.
authors.affiliation: Laboratory for Prenatal Medicine, Department of Biomedicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Ines
authors.initials: I
authors.lastname: Kaufmann
authors.forename: Corinne
authors.initials: C
authors.lastname: Rusterholz
authors.forename: Irene
authors.initials: I
authors.lastname: Hösli
authors.forename: Sinuhe
authors.initials: S
authors.lastname: Hahn
authors.forename: Olav
authors.initials: O
authors.lastname: Lapaire
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis*; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood; D012372:ROC Curve; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1