P 58 The dynamics of repeated measurements of the sFlt-1/PlGF-RN ratio and the remaining pregnancy duration in patients with RN suspected preeclampsia <34 weeks of gestation

Autor: Andreas Busjahn, Stefan Verlohren, Wolfgang Henrich, N Klöckner, J Pullankavumkal, P Kreße-Chludek
Rok vydání: 2017
Předmět:
Zdroj: Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health. 9:62
ISSN: 2210-7789
Popis: Background The ratio of soluble fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PIGF) has been established as a biomarker to rule out suspected preeclampsia with a negative predictive value of above 99% (for peak sFlt-1/PIGF-values 38). We have observed that, in contrast to women with suspected preeclampsia, in women with intrauterine growth restriction sFlt-1/PIGF does not seem to be predictive for premature delivery, despite equally elevated peak levels of sFlt-1/PIGF. Based on our clinical experience, we suspect that the gradient/slope between two sFlt-1/PIGF values determined at two consecutive time points may discriminate these two entities at risk for premature delivery with equally elevated peak sFlt-1/PIGF-values. Moreover, we hypothesized that this gradient of sFlt-1/PIGF increase over time, may help to better define the risk of premature delivery due to preeclampsia in patients with IUGR. Methods This is a retrospective monocenter study, including patients that presented with either suspected early onset preeclampsia or IUGR, with at least two consecutive routine sFlt-1/PIGF measurements. We analyzed outcome data from women who gave birth in our perinatal care center in the years 2010–2016. We compared women of both clinical entities with respect to the gradient of intraindividual sFlt-1/PIGF level changes over time and the ability of this measure to predict remaining pregnancy time using healthy pregnant woman as a reference. Results A total of 111 women were included (diagnosis at delivery: IUGR, n = 27; PE, n = 35; IUGR + PE, n = 10; healthy control, n = 12; others n = 39). As expected we found elevated sFlt-1/PIGF level in women with PE at delivery (mean 131,5). Woman with IUGR displayed similarly elevated levels (94,0), and peak sFlt-1/PIGF level did not allow for discrimination of the two entities. However, we found the highest peak sFlt-1/PIGF levels in women with the diagnosis of both PE and IUGR at delivery (mean 235). Looking at the mean gradient of the sFlt-1/PIGF changes over time, we found a similar pattern with comparable values for PE (3,54/d) and IUGR (2,53/d), but much steeper slopes (9,63/d) in woman with the diagnosis of IUGR + PE at delivery. However, due to a pronounced interindividual variability in the IUGR + PE group, this finding did not reach statistical significance. Discussion Patients with IUGR display elevated sFlt-1/PIGF levels, even in the absence of preeclampsia. It appears that the slope between two measurements of sFlt-1/PIGF is steeper in IUGR-patients at risk for PE. The measurement of the sFlt-1/PIGF gradient over time followed a similar pattern in PE and IUGR. In contrast the IUGR + PE group displayed a substantially higher gradient. Therefore, the introduction of a slope in addition to single absolute values might improve prediction of adverse events in placental dysfunction disorders. However, adequately powered prospective studies will be needed to define sFlt-1/PIGF cut off levels in woman with IUGR and the additional predictive value of the sFlt-1/PIGF gradient over time.
Databáze: OpenAIRE
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