title: Diagnostic Biomarkers in Women With Suspected Preeclampsia in a Prospective Multicenter Study.
abstract: To evaluate 47 biomarkers (selected from the current medical literature), in isolation or in combination with placental growth factor (PlGF), to determine the need for delivery within 14 days, in women presenting with suspected preterm preeclampsia.
  
  
  
  In a prospective, multicenter observational study, 47 biomarkers were measured in 423 women presenting with suspected preterm preeclampsia (in two prespecified groups: group 1 at less than 35 weeks of gestation and group 2 presenting between 35 0/7 and 36 6/7 weeks of gestation) to evaluate their ability to determine the primary endpoint: preeclampsia requiring delivery within 14 days. Using factor analysis and stepwise logistic regression, we sought one or more additional biomarkers for optimal determination of the primary endpoint.
  
  
  
  In women presenting at less than 35 weeks of gestation (n=286), the best performing combination of PlGF, podocalyxin, endoglin, procalcitonin (receiver operating curve [ROC] area 0.90, 95% confidence interval [CI] 0.86-0.93) was not statistically better than PlGF alone (ROC 0.87, 95% CI 0.83-0.92; P=.43) for preeclampsia requiring delivery within 14 days. Two other single markers had test performance that was not significantly different to PlGF (soluble fms-like tyrosine kinase-1 [sFlt-1] ROC 0.83, 95% CI 0.78-0.88; endoglin ROC 0.83, 95% CI 0.79-0.88). Similar findings were found in women presenting between 35 0/7 and 36 6/7 weeks of gestation (n=137): ROC for PlGF alone 0.75 (95% CI 0.67-0.83); ROC for PlGF, cystatin, pregnancy-associated plasma protein A in combination 0.81 (95% CI 0.74-0.88; P=.40).
  
  
  
  This study supports the growing body of evidence that a single angiogenesis-related biomarker (PlGF, sFlt-1, or endoglin) alone represents a useful diagnostic test for women presenting with suspected preterm preeclampsia.
authors.affiliation: Women's Health Academic Centre, King's College London, London, the Maternal and Fetal Health Research Centre, University of Manchester, Manchester, Nuffield Department of Obstetrics and Gynaecology, University of Oxford, and Oxford University Hospital NHS Trust, Oxford, the Division of Women's and Children's Health, University of Leeds, Leeds, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, and the Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield, United Kingdom; and INFANT Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland.
authors.forename: Suzy
authors.initials: S
authors.lastname: Duckworth
authors.forename: Melanie
authors.initials: M
authors.lastname: Griffin
authors.forename: Paul T
authors.initials: PT
authors.lastname: Seed
authors.forename: Robyn
authors.initials: R
authors.lastname: North
authors.forename: Jenny
authors.initials: J
authors.lastname: Myers
authors.forename: Lucy
authors.initials: L
authors.lastname: Mackillop
authors.forename: Nigel
authors.initials: N
authors.lastname: Simpson
authors.forename: Jason
authors.initials: J
authors.lastname: Waugh
authors.forename: Dilly
authors.initials: D
authors.lastname: Anumba
authors.forename: Louise C
authors.initials: LC
authors.lastname: Kenny
authors.forename: Christopher W G
authors.initials: CWG
authors.lastname: Redman
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Shennan
authors.forename: Lucy C
authors.initials: LC
authors.lastname: Chappell
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood; D015891:Cystatins / Q000097:blood; D036861:Delivery, Obstetric; D000071063:Endoglin / Q000097:blood; D005260:Female; D005865:Gestational Age; D006801:Humans; D000072483:Placenta Growth Factor / Q000097:blood*; D011225:Pre-Eclampsia / Q000097:blood* / Q000175:diagnosis*; D011247:Pregnancy; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism; D011446:Prospective Studies; D012372:ROC Curve; D012795:Sialoglycoproteins / Q000097:blood; D013997:Time Factors; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood
chemical_list: D015415:Biomarkers; D015891:Cystatins; D000071063:Endoglin; D012795:Sialoglycoproteins; C001643:podocalyxin; D000072483:Placenta Growth Factor; D002116:Calcitonin; D040281:Vascular Endothelial Growth Factor Receptor-1; D011266:Pregnancy-Associated Plasma Protein-A