Risk for Imminent Delivery in Preeclampsia Based on the sFlt-1/PlGF Ratio: Do We Need New Cut-Offs?

Abstract

Introduction

It is still difficult to predict the outcome of preeclampsia and determine the individual procedure with regards to the time of birth. Cut-offs of the sFlt-1/PlGF ratio with a high risk for imminent delivery have been previously published and analyzed by our study group, but could not be confirmed. The aim of the current study is to re-evaluate the described cut-off values again in a new period of time.

Materials and Methods

We performed a retrospective analysis (IRB 1279/2020) including all preeclampsia patients delivering in our department over a 3-year period. Patients were divided into 2 groups – gestational week 24+0–33+6 with an s-Flt1/PlGF > 655.2 and 34+0–37+0 weeks with an sFlt-1/PlGF > 201 and were compared with preeclampsia patients of the same weeks with sFlt-1/PlGF values below the described cut-offs. Correlation between sFlt-1/PlGF ratio and time to delivery was assessed.

Results

The association between sFlt-1/PlGF above the threshold and delivery within 48 h is significant for the high ratio early group (p < 0.01) but not for the high ratio late group (p = 0.62). In the early group, 60% of patients with sFlt-1/PlGF > 655.2 but only 8% in the low ratio group delivered within 48 h. In both the early and the late preeclampsia group, a high number of patients remained pregnant even though they showed elevated ratios.

Conclusion

High sFlt-1/PlGF ratios seem to correlate with a shorter pregnancy duration to some extent. Nevertheless, not all patients need to be delivered within 48 h, so the decision should never be based on the laboratory test alone.

Zusammenfassung

Einleitung

Es ist immer noch schwierig, das Outcome bei Präeklampsie vorherzusagen und das individuelle Vorgehen hinsichtlich des richtigen Zeitpunkts der Entbindung festzulegen. Unsere Arbeitsgruppe hat zwar Schwellenwerte für den sFlt-1/PlGF-Quotienten, die mit einem höheren Risiko für eine bevorstehende Entbindung verbunden sind, veröffentlicht und analysiert, aber die Werte konnten bisher nicht bestätigt werden. Ziel dieser aktuellen Studie war es, eine Neubewertung der beschriebenen Schwellenwerte für einen neuen Zeitabschnitt vorzunehmen.

Material und Methoden

Es wurde eine retrospektive Analyse (IRB 1279/2020) der Patientinnen vorgenommen, die innerhalb von 3 Jahren in unserer Abteilung entbunden haben, einschließlich aller Patientinnen mit Präeklampsie. Die Patientinnen wurden in 2 Gruppen eingeteilt: Schwangerschaftswoche 24+0–33+6 mit einem s-Flt1/PlGF > 655,2 und Schwangerschaftswoche 34+0–37+0 mit einem sFlt-1/PlGF > 201. Die Gruppen wurden mit Patientinnen mit Präeklampsie in derselben Schwangerschaftswoche und mit demselben sFlt-1/PlGF-Quotienten unterhalb der oben beschriebenen Schwellenwerte verglichen. Die Korrelation zwischen dem sFlt-1/PlGF-Quotienten und der Zeit bis zur Entbindung wurde bewertet.

Ergebnisse

Die Beziehung zwischen sFlt-1/PlGF-Quotienten oberhalb des Schwellenwerts und einer Entbindung innerhalb von 48 Stunden war signifikant für die früh entbundene Gruppe mit einem hohen Quotienten (p < 0,01), nicht aber für die spät entbundene Gruppe mit einem hohen Quotienten (p = 0,62). In der Gruppe der früh Entbundenen haben 60% der Patientinnen mit einem sFlt-1/PlGF > 655,2, aber nur 8% mit einem niedrigen Quotienten innerhalb von 48 Stunden entbunden. Sowohl in der frühen als auch in der späten Präeklampsiegruppe blieben eine hohe Anzahl der Patientinnen schwanger, obwohl sie erhöhte Quotienten aufwiesen.

Schlussfolgerung

Höhere sFlt-1/PlGF-Quotienten scheinen bis zu einem gewissen Grad mit einer kürzeren Schwangerschaftsdauer zu korrelieren. Trotzdem müssen nicht alle Patientinnen innerhalb von 48 Stunden entbunden werden, und die Entscheidung sollte nie auf den Ergebnissen der Laboruntersuchung alleine beruhen.

Keywords

preeclampsia - sFlt-1/PlGF - soluble fms-like tyrosine kinase-1 - placental growth factor - time to delivery

Schlüsselwörter

Präeklampsie - sFlt-1/PlGF - lösliche Fms-like tyrosine kinase-1 - Plazenta-Wachstumsfaktor - Zeit zur Entbindung

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