title: Circulating angiogenic factors and urinary prolactin as predictors of adverse outcomes in women with preeclampsia.
abstract: Preeclampsia is characterized by an imbalance in angiogenic factors. Urinary prolactin (PRL) levels and its antiangiogenic PRL fragments have been associated with disease severity. In this study, we assessed whether these biomarkers are associated with an increased risk of adverse maternal and perinatal outcomes in preeclamptic women. We studied 501 women with preeclampsia attended at a tertiary care hospital. Serum concentrations of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng), as well as urinary PRL levels, were measured by enzymed-linked immunosorbent assay. Antiangiogenic PRL fragments were determined by immunoblotting. The risk for any adverse maternal outcome and for having a small-for-gestational-age infant was higher among women with sFlt-1/PlGF ratios, sEng, and urinary PRL level values in the highest quartile (odds ratios ≥ 2.7), compared with the lowest quartile. Both urinary PRL levels and the presence of antiangiogenic PRL fragments were more closely associated with the risk of specific adverse maternal outcomes (placental abruption, hepatic hematoma or rupture, acute renal failure, pulmonary edema, maternal death, and need for endotracheal intubation, positive inotropic drug support, and hemodialysis; odds ratios ≥ 5.7 and ≥ 4.7, respectively) than either sFlt-1/PlGF ratio or sEng alone. We concluded that in preeclamptic women at the time of initial evaluation, sFlt-1/PlGF ratio and sEng are associated with increased risk of combined adverse maternal outcomes. However, urinary PRL concentrations and its antiangiogenic fragments appear to be better predictors of an adverse maternal outcome and may be useful for risk stratification in preeclampsia.
authors: Research Unit in Reproductive Medicine, UMAE-Hospital de Ginecología y Obstetricia Luis Castelazo Ayala, Instituto Mexicano del Seguro Social, México DF, Mexico. alfredolm@yahoo.com
authors: Alfredo
authors: A
authors: Leaños-Miranda
authors: Inova
authors: I
authors: Campos-Galicia
authors: Karla Leticia
authors: KL
authors: Ramírez-Valenzuela
authors: Zarela Lizbeth
authors: ZL
authors: Chinolla-Arellano
authors: Irma
authors: I
authors: Isordia-Salas
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000328:Adult; D015703:Antigens, CD / Q000097:blood*; D015415:Biomarkers / Q000378:metabolism; D000071063:Endoglin; D005260:Female; D006801:Humans; D063130:Maternal Death; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000378:metabolism*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood*; D011379:Prognosis; D011388:Prolactin / Q000652:urine*; D011654:Pulmonary Edema / Q000453:epidemiology; D011956:Receptors, Cell Surface / Q000097:blood*; D012307:Risk Factors; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*
chemical_list: D015703:Antigens, CD; D015415:Biomarkers; C064206:ENG protein, human; D000071063:Endoglin; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D011956:Receptors, Cell Surface; D000072483:Placenta Growth Factor; D011388:Prolactin; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1