A prospective cohort study on the prediction of the diagnosis-to-delivery time in preeclamptic pregnancies: should the sFlt-1/PlGF ratio be added to routine evaluations?
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To analyze the clinical and laboratory factors that potentially affect the diagnosis-to-delivery time in preeclamptic pregnancies.
In this cross-sectional study, we followed 24 early onset preeclampsia (E-PE) and 26 late-onset preeclampsia (L-PE) cases. Maternal serum samples were obtained at the time of diagnosis and stored at − 80 °C until ELISA analysis for soluble fms-like tyrosine kinase-1 (SFlt-1) and placental growth factor (PlGF) levels.
The median follow-up duration was 68 (1–339) h in the E-PE group and 330 (7–1344) h in the L-PE group. Maternal mean arterial pressure (MAP) at hospitalization was the strongest variable, and the sFlt-1/PlGF ratio added significantly to the Cox regression model. In the E-PE cases, the median sFlt-1/PlGF ratio was significantly higher in the subgroup with a follow-up duration > 48 h than in the subgroup of cases with a follow-up duration ≤ 48 h (5109 vs. 2080; p = 0.038), and none of the seven cases with an sFlt-1/PlGF ratio ≥ 75th percentile delivered during the first 48 h. Neither the 24-h proteinuria nor the gestational age at diagnosis added to the predictive power of the MAP at hospitalization.
Incorporation of the sFlt-1/PlGF ratio to the routine evaluation of preeclamptic pregnancies may help in the prediction of progression and management planning.
KeywordsDiagnosis-to-delivery time Preeclampsia Placental growth factor Soluble fms-like tyrosine kinase sFlt-1/PlGF ratio
SK: involved in protocol development, data collection, data analysis, and manuscript writing; GT: laboratory analysis and data collection; GN: protocol development and data collection; SA: protocol development and manuscript editing; GHI: laboratory analysis and manuscript editing; OED: protocol development and manuscript editing.
This research was supported by a grant from Dokuz Eylul University Scientific Research Projects Coordination Unit.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
- 4.National Institute for Health and Clinical Excellence (2010) Hypertension in pregnancy: the management of hypertensive disorders during pregnancy. http://guidance.nice.org.uk/cg107. Accessed 1 Jan 2018
- 5.Churchill D, Duley L, Thornton JG, Jones L (2013) Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks’ gestation. Cochrane Database Syst Rev 7:CD003106Google Scholar
- 15.Verlohren S, Herraiz I, Lapaire O, Schlembach D, Moertl M, Zeisler H, Calda P, Holzgreve W, Galindo A, Engels T, Denk B, Stepan H (2012) The sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders and its prognostic potential in preeclamptic patients. Am J Obstet Gynecol 206:58.e1–58.e8CrossRefGoogle Scholar
- 19.Maynard SE, Min JY, Merchan J, Lim KH, Li J, Mondal S, Libermann TA, Morgan JP, Sellke FW, Stillman IE, Epstein FH, Sukhatme VP, Karumanchi SA (2003) Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest 111:649–658CrossRefPubMedCentralGoogle Scholar
- 22.Onda K, Tong S, Nakahara A, Kondo M, Monchusho H, Hirano T, Kaitu’u-Lino T, Beard S, Binder N, Tuohey L, Brownfoot F, Hannan NJ (2015) Sofalcone upregulates the nuclear factor (erythroid-derived 2)-like 2/heme oxygenase-1 pathway, reduces soluble fms-like tyrosine kinase-1, and quenches endothelial dysfunction:potential therapeutic for preeclampsia. Hypertension 65:855–862CrossRefPubMedCentralGoogle Scholar
- 24.Brownfoot FC, Hastie R, Hannan NJ, Cannon P, Tuohey L, Parry LJ, Senadheera S, Illanes SE, Kaitu’u-Lino TJ, Tong S (2016) Metformin as a prevention and treatment for preeclampsia: effects on soluble fms-like tyrosine kinase 1 and soluble endoglin secretion and endothelial dysfunction. Am J Obstet Gynecol 214:356.e1–356.e15CrossRefGoogle Scholar