| Abstrakt: |
Objectives: To evaluate the performance of a combination of angiogenic and vasoactive biomarkers to predict the development of severe pre‐eclampsia (PE)/HELLP syndrome in the third trimester. Methods: Included were 215 women referred in the third trimester to an obstetric outpatient clinic with suspected PE (mean gestational age, 35 + 4 weeks), and 94 with normal pregnancy attending a midwife clinic. Cases were categorized as having subclinical PE, essential hypertension, gestational hypertension, moderate PE, and severe PE/HELLP syndrome. Blood samples were analyzed by immunoassay and groups were compared with respect to potential clinical and biochemical biomarkers, with the primary outcome being development of severe PE/HELLP syndrome within 1 week and within 2 weeks of analysis. The most promising markers were also assessed in combination. Results: In the patients presenting with mild to moderate symptoms of PE, the individual markers which performed best for the prediction of progression to severe PE/HELLP syndrome within 1 week and within 2 weeks of biomarker evaluation were C‐terminal pro‐endothelin‐1 (CT‐pro‐ET‐1) (area under the receiver–operating characteristics curve (AUC), 0.82 and 0.78, respectively), soluble fms‐like tyrosine kinase‐1 (sFlt‐1) (AUC, 0.81 and 0.76), systolic blood pressure (AUC, 0.80 and 0.68) and midregional pro‐atrial natriuretic peptide (AUC, 0.79 and 0.77). The combination of biomarkers with the best performance was CT‐pro‐ET‐1, sFlt‐1 and systolic blood pressure, achieving an AUC of 0.94 for prediction of development of severe PE/HELLP syndrome within 1 week and an AUC of 0.83 for prediction of their development within 2 weeks of biomarker evaluation. Conclusions: The performance of CT‐pro‐ET‐1 for prediction of the development of PE/HELLP syndrome in the third trimester was promising, especially in combination with sFlt‐1 and systolic blood pressure. This was an exploratory study and our findings should be confirmed in further studies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR] |
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