title: The sFlt-1/PlGF ratio associates with prolongation and adverse outcome of pregnancy in women with (suspected) preeclampsia: analysis of a high-risk cohort.
abstract: OBJECTIVE
  To evaluate the additive value of the sFlt-1/PlGF ratio for diagnosing preeclampsia (PE) and predicting prolongation of pregnancy and adverse outcome in a cohort of women with PE or at high risk of PE.
  
  
  METHODS
  Patients with suspected or confirmed clinical PE were recruited. At time of inclusion blood for measurement of sFlt-1and PlGF was taken. Values were determined after delivery. A cut-off ratio of ≥85 was defined as a positive test.
  
  
  RESULTS
  A total of 107 patients were included. Of the patients, 62 (58%) met the clinical criteria of PE at time of blood sampling. In 10% of these patients (n=6) the ratio was <85 (false negative), whereas in 7% (n=3) of patients without clinical PE the ratio was ≥85 (false positive), resulting in positive and negative predictive values of 95% and 88% respectively. One patient with false positive ratio developed superimposed PE and 2 developed gestational hypertension, and adverse outcome occurred in all three. An adverse pregnancy outcome was only encountered in 1 of the 6 patients with a false negative ratio. Using a binary regression model with adjustment for gestational age <34 weeks, the adverse outcome risk was 11 times increased on the basis of clinical PE, and 30 times on the basis of an elevated ratio (P=0.036).
  
  
  CONCLUSIONS
  The additive value of an increased ratio for diagnosing PE is limited since most patients with clinical PE also have a positive ratio. However, an elevated ratio is superior to the clinical diagnosis of PE for predicting an adverse pregnancy outcome. Furthermore, irrespective of clinical PE, a low ratio is inversely correlated with prolongation of pregnancy.
authors.affiliation: Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, The Netherlands; Department of Obstetrics and Gynecology, The Netherlands.
authors.forename: Langeza
authors.initials: L
authors.lastname: Saleh
authors.affiliation: Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, The Netherlands.
authors.forename: Koen
authors.initials: K
authors.lastname: Verdonk
authors.affiliation: Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, The Netherlands. Electronic address: a.danser@erasmusmc.nl.
authors.forename: A H
authors.initials: AH
authors.lastname: Jan Danser
authors.affiliation: Department of Obstetrics and Gynecology, The Netherlands.
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.affiliation: Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: Russcher
authors.affiliation: Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, The Netherlands.
authors.forename: Anton H
authors.initials: AH
authors.lastname: van den Meiracker
authors.affiliation: Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, The Netherlands; Department of Obstetrics and Gynecology, The Netherlands.
authors.forename: Willy
authors.initials: W
authors.lastname: Visser
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D000072483:Placenta Growth Factor / Q000097:blood*; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D012307:Risk Factors; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D000072483:Placenta Growth Factor; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1
keywords: Placental growth factor; Pregnancy outcome; Prolongation of pregnancy; Soluble Fms-like tyrosine kinase; sFlt-1/PlGF ratio