title: Modeling risk for severe adverse outcomes using angiogenic factor measurements in women with suspected preterm preeclampsia.
abstract: BACKGROUND
  Preeclampsia (PE) is a pregnancy-specific syndrome associated with adverse maternal and fetal outcomes. Patient-specific risks based on angiogenic factors might better categorize those who might have a severe adverse outcome.
  
  
  METHODS
  Women evaluated for suspected PE at a tertiary hospital (2009-2012) had pregnancy outcomes categorized as 'referent' or 'severe', based solely on maternal/fetal findings. Outcomes that may have been influenced by a PE diagnosis were considered 'unclassified'. Soluble fms-like tyrosine kinase (sFlt1) and placental growth factor (PlGF) were subjected to bivariate discriminant modeling, allowing patient-specific risks to be assigned for severe outcomes.
  
  
  RESULTS
  Three hundred twenty-eight singleton pregnancies presented at ≤34.0 weeks' gestation. sFlt1 and PlGF levels were adjusted for gestational age. Risks above 5 : 1 (10-fold over background) occurred in 77% of severe (95% CI 66 to 87%) and 0.7% of referent (95% CI <0.1 to 3.8%) outcomes. Positive likelihood ratios for the modeling and validation datasets were 19 (95% CI 6.2-58) and 15 (95% CI 5.8-40) fold, respectively.
  
  
  CONCLUSIONS
  This validated model assigns patient-specific risks of any severe outcome among women attending PE triage. In practice, women with high risks would receive close surveillance with the added potential for reducing unnecessary preterm deliveries among remaining women. © 2015 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.
authors: Department of Pathology and Laboratory Medicine, Women & Infants Hospital/Alpert Medical School at Brown University, Providence, RI, USA; Savjani Institute for Health Research, Windham, ME, USA.
authors: Glenn E
authors: GE
authors: Palomaki
authors: James E
authors: JE
authors: Haddow
authors: Hamish R M
authors: HR
authors: Haddow
authors: Saira
authors: S
authors: Salahuddin
authors: Carl
authors: C
authors: Geahchan
authors: Ana Sofia
authors: AS
authors: Cerdeira
authors: Stefan
authors: S
authors: Verlohren
authors: Frank H
authors: FH
authors: Perschel
authors: Gary
authors: G
authors: Horowitz
authors: Ravi
authors: R
authors: Thadhani
authors: S Ananth
authors: SA
authors: Karumanchi
authors: Sarosh
authors: S
authors: Rana
mesh_terms: D000328:Adult; D043925:Angiogenesis Inducing Agents; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000175:diagnosis*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011257:Pregnancy Proteins / Q000097:blood*; D018570:Risk Assessment; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*
chemical_list: D043925:Angiogenesis Inducing Agents; D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1
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