Abstract
Objective Increased expression of soluble fms-like tyrosine kinase 1 (sFlt-1), associated with
a decrease in placental growth factor (PlGF), plays a key role in the pathogenesis
of preeclampsia (PE). We evaluated the prognostic value of the sFlt-1/PlGF ratio for
the onset of adverse maternofetal outcomes (AMFO) in case of early-onset PE with attempted
expectant management.
Study Design From October 2016 through November 2018, all singleton pregnancies complicated by
early-onset PE (before 34 weeks of gestation) were included in a cohort study. The
plasma levels of sFlt-1 and PlGF were blindly measured on admission. For the statistical
analysis, we performed a bivariate analysis, a comparison of the receiving operating
characteristic curves and a survival analysis estimated by the Kaplan–Meier method.
Results Among 109 early PE, AMFO occurred in 87 pregnancies (79.8%), mainly hemolysis, elevated
liver enzymes, and low platelet count syndrome and severe fetal heart rate abnormalities
requiring urgent delivery. The area under the curve (AUC) of sFlt-1/PlGF ratio was
0.82 (95% confidence interval [CI]: 0.73–0.88) for the risk of AMFO and the difference
between the AUCs was significant for each separate standard parameter (p = 0.018 for initial diastolic blood pressure, p = 0.013 for alanine aminotransferase, p < 0.001 for uric acid). Pregnancies were best classified by a cutoff ratio of 293,
with a sensitivity of 95% and a specificity of 50%. With a ratio value less than 293,
no pregnancy was complicated or had been stopped during the first 5 days. A ratio
more than 293 was associated with an increased risk of AMFO onset (hazard ratio [HR]:
3.61; 95% CI: 2.13–6.10; p < 0.001) and had a significant association with the length of time between the diagnosis
of PE and delivery (HR: 2.49; 95% CI: 1.56–3.96; p < 0.001).
Conclusion The sFlt-1/PlGF ratio is an additional tool in the prediction of AMFO in proven early-onset
PE, which is likely to improve care by anticipating severe complications.
Key Points
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The sFlt-1/PlGF ratio is associated with AMFO.
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It is an additional tool for physician.
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We proposed a 293 cutoff value for the ratio.
Keywords
preeclampsia - adverse maternofetal outcomes - prognostic - pregnancy - sFlt-1/PlGF
