The use of Elecsys PlGF and sFlt-1 test systems to predict perinatal outcomes in patients with severe preeclampsia
Objective. To find a threshold level for soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor placental growth factor (PlGF) and serum sFlt-1/PlGF ratios as predictors of poor perinatal outcomes in patients with severe preeclampsia.Kurtser M.A., Shamanova M.B., Sinitsina O.V., Nikolaev A.A., Nikolaeva E.V., Dedlovskaya A.I., Samsonova M.A.
Subjects and methods. The investigation enrolled 28 pregnant women with severe preeclampsia. According to perinatal outcomes, all the patients were divided into 3 groups: 1) 5 patients with perinatal losses; 2) 7 patients without the latter, but with intermediate perinatal outcomes (Apgar scores of less than or equal to 7 at five minutes; a neonatal umbilical cord pH less than 7.2 at birth; a lactate level greater than or equal to 4.8); 3) 16 patients without losses with favorable perinatal outcomes (Apgar scores of more than 8 at five minutes; an umbilical cord pH more than or equal to 7.2 at birth; and a lactate level less than 4.8).
Results. The level of sFlt-1/PlGF was statistically significantly higher in the patients with perinatal losses than in those in Groups 2 and 3 [1162 (940-1276) vs 277 (233-335) and 137 (120-396)]. In Group 1, the PlGF score was lower than in the intermediate and favorable perinatal outcome groups [15 (13-17) vs 75 (44-112) and 68 (32-78), respectively]. There were no group differences in the serum concentration of sFlt-1.
Conclusion. Determination of the sFlt-1/PlGF ratio and the serum concentration of PlGF can be used as a predictor of poor perinatal outcomes. The threshold level for the sFLt-1/PlGF ratio for predicting perinatal losses was 1197, with a sensitivity of 60% and a specificity of 96%. Estimation of the sFlt-1/PlGF ratio is an additional tool not only for diagnosing preeclampsia and for determining the severity of PE, but also for defining the time of delivery in order to prevent poor perinatal complications.
Keywords
preeclampsia
perinatal outcomes
placental growth factor (PlGF)
soluble fms-like tyrosine kinase-1 (sFlt-1)
References
- Hernandez-Diaz S., Toh S., Cnattingius S. Risk of preeclamsia in ferst and subsequent pregnancies: prospective cohort study. BMJ. 2009; 338: b2255.
- Skjaerven R., Wilcox A.J., Lie R.T. The interval between pregnancies and the rrisk of preeclampsia. N. Engl. J. Med. 2002; 346(1): 33-8.
- Ananth C.V., Keyes K.M., Wapner R.J. Preeclamsia rates in the United States. 1980-2010: age-period-cohort analysis. BMJ. 2013; 347: f6564.
- Sibai B., Dekker G., Kupferminc M. Pre-eclampsia. Lancet. 2005; 365(9461): 785-99.
- Kendall R.L., Thomas K.A. Inhibition of vascular endothelial cell growth factor activity by an endogenously encoded soluble receptor. Proc. Natl. Acad. Sci. USA. 1993; 90(22): 10705-9.
- Lu F., Longo M., Tamayo E., Maner W., Al-Hendy A., Anderson G.D. et al. The effect of over-expression of sFlt-1 on blood pressure and the occurrence of other manifestations of preeclampsia in unrestrained conscious pregnant mice. Am. J. Obstet. Gynecol. 2007; 196(4): 396. e1-7.
- Karumanchi S.A., Maynard S.E., Stillman I.E., Epstein F.H., Sukhatme V.P. Preeclampsia: a renal perspective. Kidney Int. 2005; 67(6): 2101-13.
- Zhang J., Klebanoff M.A., Roberts J.M. Prediction of adverse outcomes by common definitions of hypertension in pregnancy. Obstet. Gynecol. 2001; 97(2): 261-7.
- Sibi B.M. Hypertension in pregnancy. In: Cabe S.G., Niebyl J.R., Simpson J.L., eds. Obstetrics: normal and problem pregnancies. 3rd ed. New York: Churchill Livingstone; 1996: 935-97.
- Page E.W., Christianson R. Influence of blood pressure changes with and without proteiuria upon outcome of pregnancy. Am. J. Obstet. Gynecol. 1976; 126:821-33.
- Zeisler H., Llurba E., Chantraine F., Vatish M., Staff A.C., Sennström M. et al. Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia. N. Engl. J. Med. 2016; 374(1): 13-22.
- Курцер М.А., Шаманова М.Б., Синицина О.В., Николаев А.А., Дедловская А.И., Самсонова М.А. Клиническое обоснование определения соотношения sFlt-1/PlGF с целью раннего выявления и оценки степени тяжести преэклампсии. Акушерство и гинекология. 2018; 11: 114-20. [Kurcer M.A., Shamanova M.B., Sinicina O.V., Nikolaev A.A., Dedlovskaja A.I., Samsonova M.A. Klinicheskoe obosnovanie opredelenija sootnoshenija sFlt-1/PlGF s cel’ju rannego vyjavlenija i ocenki stepeni tjazhesti prejeklampsii. Akushestvo i ginekologija. 2018; 11: 114-20. (In Russian)]. https://dx.doi.org/10.18565/aig.2018.11.114-120
- Verlohren S., Herraiz I., Lapaire O., Schlembach D., Moertl M., Zeisler H. et al. The sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders and its prognostic potential in preeclamptic patients. Am. J. Obstet. Gynecol. 2012; 206(1): 58. e1-8.
- Gomez-Arriaga P.L., Herraiz I., Lopez-Jimenez E.A., Escribano D., Denk B., Galindo A. Uterine artery Doppler and sFlt-1/Plgf ratio: prognostic value in early-onset preeclampsia. Ultrasound Obstet. Gynecol. 2014; 43(5): 525-32.
- Meler E., Figueras F., Mula R., Crispi F., Benassar M., Gomes O., Gratacos E. Prognostic role of uterine artery Doppler in patients with preeclampsia. Fetal Diagn. Ther. 2010; 27: 8-13.
- Rana S., Powe C.E., Salahuddin S., Verlohren S., Perschel F.H., Levine R.J. et al. Angiogenic factors and the risk of adverse outcomes in women with suspected preeclamsia. Circulation. 2012; 125(7): 911-9.
- Гипертензивные расстройства во время беременности, в родах и послеродовом периоде. Преэклампсия. Эклампсия. Клинические рекомендации (протокол лечения). М.; 2016. [Gipertenzivnye rasstrojstva vo vremja beremennosti, v rodah i poslerodovom periode. Prejeklampsija. Jeklampsija. Klinicheskie rekomendacii (protokol lechenija). M.; 2016. (In Russian)].
- Shear R.M., Rinfret D., Leduc L. Should we offer expectant management in cases of severe preterm preeclampsia with fetal growth restriction? Am. J. Obstet. Gynecol. 2005; 192(4): 1119-25.
- Mitani M., Matsuda Y., Macino Y., Akizawa Y., Ohta H. Clinical features of fetal growth restriction complicated later by preeclampsia. J. Obstet. Gynaecol. Res. 2009; 35(5): 882-7.
- Benton S.J., Hu Y., Xie F., Kupfer K., Lee S.W., Magee L.A., von Dadelszen P. Can placental growth factor in maternal circulation identify fetses with placental intrauterine growth restriction? Am. J. Obstet. Gynecol. 2012; 206(2):163. e1-7.
- Engineer N., Kumar S. Perinatal variables and neonatal outcomes in severey growth restricted preterm fetuses. Acta Obstet. Gynecol. Scand. 2010; 89(9): 1174-81.
- Garite T.J., Clark R., Thorp J.A. Intrauterine growth restriction increases morbidity and mortality among premature neonates. Am. J. Obstet. Gynecol. 2004; 191(2): 481-7.
- Stolz M., Zeisler H., Heinzl F., Binder J., Farr A. An sFlt-1:PlGF ratio of 655 is not a reliable cut-off value for predicting perinatal outcomes in women with preeclampsia. Pregnancy Hypertens. 2018; 11: 54-60.
- Leaños-Miranda A., Méndez-Aguilar F., Ramírez-Valenzuela K.L., Serrano-Rodríguez M., Berumen-Lechuga G., Molina-Pérez C.J. et al. Circulating angiogenic factors are related to the severity of gestational hypertension and preeclampsia, and their adverse outcomes. Medicine (Baltimore). 2017; 96(4): e6005.
Received 30.09.2019
Accepted 04.10.2019
About the Authors
Kurtser Mark A. - Academician of the Russian Academy of Sciences, Professor, Head of the Department of Obstetrics and Gynecology of the Pediatric Faculty of the Russian National Research Medical University named after N.I. Pirogov, CEO of the Group of Companies “Mother and Child”. Perinatal medical center of the group of companies “Mother and Child”, Moscow, Russian Federation.Shamanova Maria B. - Head of the Department of Miscarriage Treatment, Perinatal Medical Center Group of Companies “Mother and Child”, Moscow, Sevastopolsky Avenue, 24, k1, e-mail:m.shamanova@mcclinics.ru
Sinitsina Olga V. - Head of the Laboratory Service of the Perinatal Medical Center Group of Companies “Mother and Child”, Moscow, Sevastopolsky Avenue, 24, k1.
e-mail:o.sinitsina@mcclinics.ru
Nikolaev Alexander A. - Head of the Clinical Diagnostic Laboratory of the Clinical Hospital Lapino Group of Companies “Mother and Child”, Moscow region, Odintsovo district, 1st Uspenskoe highway, village Lapino, 111. e-mail:a.nicolaev@mcclinics.ru
Nikolaeva Elena V., Head of the Clinical Diagnostic Laboratory of Perinatal Medical Center Group of Companies “Mother and Child”, Moscow, Sevastopolsky Avenue, 24, k1, e-mail:e.nikolaeva@mcclinics.ru
Dedlovskaya Anastasia I. - doctor obstetrician-gynecologist, Perinatal Medical Center Group of Companies “Mother and Child”, Moscow, Sevastopolsky Avenue, 24, k1, e-mail: a.dedlovskaya@mcclinics.ru
Samsonova Magshuka A. - Clinical Resident, Perinatal Medical Center Group of Companies “Mother and Child”, Moscow, Sevastopolsky Avenue, 24, k1,
e-mail: ma.samsonova@mcclinics.ru
For citation: Kurtser M.A., Shamanova M.B., Sinitsina O.V., Nikolaev A.A., Nikolaeva E.V., Dedlovskaya A.I., Samsonova M.A.The use of Elecsys PlGF and sFlt-1 test systems to predict perinatal outcomes in patients with severe preeclampsia.
Akusherstvo i Ginekologiya/ Obstetrics and gynecology. 2019; 10: 162-70. (In Russian).
https://dx.doi.org/10.18565/aig.2019.10.162-170
Similar Articles
