Added value of angiogenic factors for the prediction of early and late preeclampsia in the first trimester of pregnancy

Francesca Crovetto, Francesc Figueras, Stefania Triunfo, Fatima Crispi, Victor Rodriguez-Sureda, Anna Peguero, Carmen Dominguez, Eduard Gratacos
Fetal Diagnosis and Therapy 2014, 35 (4): 258-66

OBJECTIVE: To explore the predictive role of angiogenic factors for the prediction of early and late preeclampsia (PE) in the first trimester.

METHODS: A nested case-control study, within a cohort of 5,759 pregnancies, including 28 cases of early, 84 of late PE (cut-off 34 weeks) and 84 controls. Maternal characteristics, mean blood pressure (MAP), uterine artery (UtA) Doppler (11-13 weeks), vascular endothelial growth factor, placental growth factor (PlGF), soluble Fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (8-11 weeks) were measured/recorded. All parameters were normalized by logarithmic transformation; logistic regression analysis was used to predict PE.

RESULTS: For early PE, significant contributions were chronic hypertension, previous PE, MAP, UtA Doppler, PlGF and sFlt-1. A model including these predictors achieved detection rates (DR) of 77.8 and 88.9% for 5 and 10% false-positive rates (FPR), respectively (AUC 0.958; 95% CI 0.920-0.996). For late PE, significant contributions were provided by body mass index, previous PE, UtA Doppler, PlGF and sFlt-1. The model including these factors achieved DR of 51.2 and 69% at 5 and 10% FPR, respectively (AUC 0.888; 95% CI 0.840-0.936).

CONCLUSIONS: Among angiogenic factors, not only PlGF but also sFlt-1 substantially improve the prediction for early and late PE. The data need confirmation in larger studies.

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