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• W3100013323 abstract "Preeclampsia (PE) is a complex and heterogeneous disorder of pregnancy. Current clinical diagnostic criteria are nonspecific and correlate poorly with adverse fetal and maternal outcomes. The recently introduced angiogenic biomarkers soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are used in Europe as an aid in the management of patients with a suspected disease. They have been shown to improve risk stratification, time to diagnosis, and outcomes.1Cerdeira A.S. O’Sullivan J. Ohuma E.O. et al.Randomized interventional study on prediction of preeclampsia/eclampsia in women with suspected preeclampsia: Inspire.Hypertension. 2019; 74: 983-990Crossref PubMed Scopus (21) Google Scholar, 2Duhig K.E. Myers J. Seed P.T. et al.Placental growth factor testing to assess women with suspected pre-eclampsia: a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial.Lancet. 2019; 393: 1807-1818Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar, 3Stepan H. Hund M. Andraczek T. Combining biomarkers to predict pregnancy complications and redefine preeclampsia: the angiogenic-placental syndrome.Hypertension. 2020; 75: 918-926Crossref PubMed Scopus (18) Google Scholar Widespread sFlt-1 or PlGF use in Europe followed the publication of the PROGNOSIS study,4Zeisler H. Llurba E. Chantraine F. et al.Soluble fms-Like tyrosine kinase-1-to-placental growth factor ratio and time to delivery in women with suspected preeclampsia.Obstet Gynecol. 2016; 128: 261-269Crossref PubMed Scopus (44) Google Scholar which showed a very high negative predictive value of the sFlt-1–to–PlGF ratio cutoff of 38 (99.3%; 95% confidence interval [CI], 97.9–99.9) for patients presenting with a suspected disease between 24 0/7 and 36 6/7 weeks’ gestation. A ratio of ≤38 is now used to rule out PE and safely discharge patients with a suspected disease.3Stepan H. Hund M. Andraczek T. Combining biomarkers to predict pregnancy complications and redefine preeclampsia: the angiogenic-placental syndrome.Hypertension. 2020; 75: 918-926Crossref PubMed Scopus (18) Google Scholar However, the reported positive predictive value (PPV) for a ratio of >38 ruling in PE in the following 4 weeks was low (PPV=36.7%; 95% CI, 28.4–45.7), which is less than optimal for clinical decision making.4Zeisler H. Llurba E. Chantraine F. et al.Soluble fms-Like tyrosine kinase-1-to-placental growth factor ratio and time to delivery in women with suspected preeclampsia.Obstet Gynecol. 2016; 128: 261-269Crossref PubMed Scopus (44) Google Scholar A higher cutoff could be more appropriate as a rule in. A cutoff of ≥85 has been associated with the development of adverse outcomes in patients with suspected PE5Rana S. Powe C.E. Salahuddin S. et al.Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia.Circulation. 2012; 125: 911-919Crossref PubMed Scopus (380) Google Scholar and has also been suggested as an aid in the diagnosis3Stepan H. Hund M. Andraczek T. Combining biomarkers to predict pregnancy complications and redefine preeclampsia: the angiogenic-placental syndrome.Hypertension. 2020; 75: 918-926Crossref PubMed Scopus (18) Google Scholar; however, its performance was not assessed in the PROGNOSIS study. Therefore, we evaluated the performance of the sFlt-1–to–PlGF ratio cutoff of ≥85 for ruling in PE within 4 weeks in patients with a suspected disease. This is a posthoc analysis of the INSPIRE trial,1Cerdeira A.S. O’Sullivan J. Ohuma E.O. et al.Randomized interventional study on prediction of preeclampsia/eclampsia in women with suspected preeclampsia: Inspire.Hypertension. 2019; 74: 983-990Crossref PubMed Scopus (21) Google Scholar a randomized clinical trial assessing the use of the sFlt-1–to–PlGF ratio in women with suspected PE (n=370). Our population is similar to that of the PROGNOSIS study: patients with suspected disease and with a similar prevalence of PE (23%). Patients who presented with suspected PE between 24 0/7 and 36 6/7 weeks’ gestation had an sFlt-1–to–PlGF ratio test performed and were assigned to reveal (test results known to clinicians) or nonreveal (results unknown) trial arms.1Cerdeira A.S. O’Sullivan J. Ohuma E.O. et al.Randomized interventional study on prediction of preeclampsia/eclampsia in women with suspected preeclampsia: Inspire.Hypertension. 2019; 74: 983-990Crossref PubMed Scopus (21) Google Scholar The primary endpoint of the INSPIRE clinical trial was admission within 24 hours of the test. Secondary endpoints of the INSPIRE trial were PE and other maternal and fetal adverse outcomes.1Cerdeira A.S. O’Sullivan J. Ohuma E.O. et al.Randomized interventional study on prediction of preeclampsia/eclampsia in women with suspected preeclampsia: Inspire.Hypertension. 2019; 74: 983-990Crossref PubMed Scopus (21) Google Scholar The predictive performance of the sFlt-1–to–PlGF ratio cutoff of 85 was assessed by calculating the sensitivity, specificity, PPV, and respective 95% CIs. The PPV of the sFlt-1–to–PlGF ratio of ≥85 for ruling in PE within 4 weeks was 71.4% (95% CI, 51.3–86.8), significantly higher than the reported 36.7% (95% CI, 28.4–45.7) for a cutoff of 38 (Table).TablePerformance of soluble fms-like tyrosine kinase-1–to–placental growth factor ratio of 85 for ruling in preeclampsia within 4 weeksCutoff of 85% (95% CI)VariableAll data sets (n=370)Nonreveal (n=184)Reveal (n=186)PE 4 wk: rule in (cutoff of 85)PPV71.7 (57.7–83.2)72 (50.6–87.9)71.4 (51.3–86.8)Sensitivity60.3 (47.2–72.4)64.3 (44.1–81.4)57.1 (39.4–73.7)Specificity95.1 (92.1–97.2)95.5 (91–98.2)94.7 (89.8–97.7)CI, confidence interval; PE, preeclampsia; PPV, positive predictive value.Cerdeira. Placental soluble fms-like tyrosine kinase-1–to–placental growth factor ratio ≥85 for ruling in preeclampsia within 4 weeks. Am J Obstet G ynecol 2021. Open table in a new tab CI, confidence interval; PE, preeclampsia; PPV, positive predictive value. Cerdeira. Placental soluble fms-like tyrosine kinase-1–to–placental growth factor ratio ≥85 for ruling in preeclampsia within 4 weeks. Am J Obstet G ynecol 2021. Patients with suspected PE and an sFlt-1–to–PlGF ratio of ≥85 are at increased risk of developing PE within the next 4 weeks and may warrant either increased surveillance or admission. Interrogation of larger data sets and meta-analysis would allow external validation and increased precision. Combining this cutoff of ≥85 with the rule out cutoff of ≤38 could improve the management of patients with suspected PE." @default.
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• W3100013323 title "Performance of soluble fms-like tyrosine kinase-1–to–placental growth factor ratio of ≥85 for ruling in preeclampsia within 4 weeks" @default.
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