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2017 ; 69
(4
): 731-738
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Prediction of Preeclampsia Using the Soluble fms-Like Tyrosine Kinase 1 to
Placental Growth Factor Ratio: A Prospective Cohort Study of Unselected
Nulliparous Women
#MMPMID28167687
Sovio U
; Gaccioli F
; Cook E
; Hund M
; Charnock-Jones DS
; Smith GC
Hypertension
2017[Apr]; 69
(4
): 731-738
PMID28167687
show ga
We sought to assess the ratio of sFlt-1 (soluble fms-like tyrosine kinase 1) to
PlGF (placental growth factor) in maternal serum as a screening test for
preeclampsia in unselected nulliparous women with a singleton pregnancy. We
studied 4099 women recruited to the POP study (Pregnancy Outcome Prediction)
(Cambridge, United Kingdom). The sFlt-1:PlGF ratio was measured using the Roche
Cobas e411 platform at ?20, ?28, and ?36 weeks of gestational age (wkGA). Screen
positive was defined as an sFlt-1:PlGF ratio >38, but higher thresholds were also
studied. At 28 wkGA, an sFlt-1:PlGF ratio >38 had a positive predictive value
(PPV) of 32% for preeclampsia and preterm birth, and the PPV was similar
comparing women with low and high prior risk of disease. At 36 wkGA, an
sFlt-1:PlGF ratio >38 had a PPV for severe preeclampsia of 20% in high-risk women
and 6.4% in low-risk women. At 36 wkGA, an sFlt-1:PlGF ratio >110 had a PPV of
30% for severe preeclampsia, and the PPV was similar comparing low- and high-risk
women. Overall, at 36 wkGA, 195 (5.2%) women either had an sFlt-1:PlGF ratio of
>110 or an sFlt-1:PlGF ratio >38 plus maternal risk factors: 43% of these women
developed preeclampsia, about half with severe features. Among low-risk women at
36 wkGA, an sFlt-1:PlGF ratio ?38 had a negative predictive value for severe
preeclampsia of 99.2%. The sFlt-1:PlGF ratio provided clinically useful
prediction of the risk of the most important manifestations of preeclampsia in a
cohort of unselected nulliparous women.