Threshold of Soluble Fms-Like Tyrosine Kinase 1/Placental Growth Factor Ratio for the Imminent Onset of Preeclampsia

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 58; no. 5; pp. 859 - 866
• Main Authors: Ohkuchi, Akihide, Hirashima, Chikako, Matsubara, Shigeki, Takahashi, Kayo, Matsuda, Yoshio, Suzuki, Mitsuaki
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01-11-2011; Lippincott Williams & Wilkins
• Subjects: Adult; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Bones, joints and connective tissue. Antiinflammatory agents; Cardiology. Vascular system; Case-Control Studies; Female; Gestational Age; Humans; Japan; Medical sciences; Pharmacology. Drug treatments; Placenta Growth Factor; Pre-Eclampsia - blood; Pre-Eclampsia - physiopathology; Pregnancy; Pregnancy Outcome; Pregnancy Proteins - blood; Reference Values; Risk Assessment; Sensitivity and Specificity; Time Factors; Vascular Endothelial Growth Factor Receptor-1 - blood; Hypertension; Tyrosine; soluble fms-like tyrosine kinase 1; Pregnancy disorders; prospective cohort study; Cardiovascular disease; Pregnancy toxemia; placental growth factor; Placenta; Aminoacid; Cohort study; Preeclampsia; prediction; soluble endoglin; Growth factor
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.111.174417

It has not been clarified whether thresholds of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF), soluble endoglin, and the sFlt-1/PlGF ratio for the imminent onset of preeclampsia (PE) exist. We hypothesized that onset thresholds for the imminent onset of PE could be determined by the distributions of these 4 markers just after the onset of PE. Study subjects were 51 PE after the onset of PE; 36 of PE, 20 of gestational hypertension, 142 of a small-for-gestational-age infant, and 400 of normal pregnant controls at 19 to 25 and 27 to 31 weeks of gestation in a prospective cohort study. The current data supported our hypothesis that onset thresholds of sFlt-1 and the sFlt-1/PlGF ratio exist. The onset thresholds of the sFlt-1/PlGF at 26 to 31 weeks of gestation were useful for detecting imminent PE with the onset at <36 weeks of gestation, showing sensitivity of 0.36 and a positive likelihood ratio and 95th percent CIs of 38 (11–132); when positive, PE occurred at 2.2±0.6 weeks (range1.4–3.0 weeks) after the measurement of the sFlt-1/PlGF ratio. The combination of sFlt-1 at 26 to 31 weeks of gestation, past history of gestational hypertension or PE, prepregnancy body mass index, and mean blood pressure at 16 to 23 weeks of gestation was useful for detecting PE with onset of <36 weeks of gestation, showing sensitivity of 0.82, and a positive likelihood ratio (95% CI) of 42 (20–88). In conclusion, the onset threshold of sFlt-1/PlGF existed and might be useful for detecting the imminent onset of PE.