[Predictive value of the sFlt1/PlGF ratio for the diagnosis of preeclampsia in high-risk patients].

BACKGROUND: A dysbalance of proangiogenic [placental growth factor (PlGF)] and antiangiogenic [soluble fms-like tyrosine kinase 1 (sFlt-1)] proteins is known to cause the symptoms of preeclampsia (PE), HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) or intrauterine growth restriction (IUGR). An increased sFlt-1/PlGF ratio ≥85 is considered a reliable diagnostic marker. Altered sFlt1 and PlGF concentrations can be detected several weeks prior to the onset of clinical symptoms. In this study we analysed the role of the sFlt1/PlGF ratio as a predictive marker for preeclampsia in a high-risk patient group.

PATIENTS AND MATERIALS: We prospectively included 68 singleton pregnancies with at least one risk factor for PE, HELLP syndrome or IUGR. During the study the patients were divided into one group with symptoms (patient group) and one group without symptoms (control group) for the above-mentioned diseases. The sFlt1/PlGF ratios were measured on admission and during the course of pregnancy.

RESULTS: During pregnancy 41% of patients developed PE, HELLP syndrome or IUGR. An increase of the absolute value of the sFlt1/PlGF ratio ≥85 was only observed in the patient group and was found to be a predictive factor for PE, HELLP syndrome or IUGR at 25+0 to 31+0 weeks of gestation (p=0.005) and after 35+0 weeks of gestation (p=0.044). Alterations of the sFlt1/PlGF ratio were observed in all patients but were higher in the patient group from 7-10 weeks prior to delivery and with the highest peak 0-2 weeks prior to delivery. Compared to the control group (mean±SD 66.9±134) absolute values of sFlt1/PlGF ratio were significantly (p=0.021) increased 0-2 weeks prior to delivery in the patient group (mean±SD 393.3±147.4). An increase of the sFlt1/PlGF ratio ≥85 0-2 weeks before delivery has shown to be predictive for one of the mentioned diseases (p=0.025).

CONCLUSIONS: In high-risk patients the sFlt1/PlGF ratio can be used for an individual risk assessment with regard to PE, HELLP syndrome or IUGR. Serial measurements permit a risk-adapted prenatal care of these patients.