Correlation of sFlt/PlGF ratio with severity of preeclampsia in an Indian population

Abstract

Pre-eclampsia (PE) affects 2–8% of pregnant women and significantly increases the risk of maternal and perinatal morbidity especially in low- and middle-income countries. There is increasing evidence to support the use of biochemical markers such as placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1), to predict severity of PE and to rule out severe disease in clinical conditions masquerading as severe PE. To assess the role of soluble fms-like tyrosine kinase1/placental growth factor in the prediction of adverse perinatal and maternal outcomes in women with pre-eclampsia in south Asian population having a higher rate of the disease and its associated complications. This was a prospective cohort study of women diagnosed as having or suspected to have pre-eclampsia who underwent biophysical and biochemical investigations to measure the severity maternal like hemodynamic indices, mean arterial pressure, fetal biometric and Doppler parameters, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). The performance of these markers, individually or in combination, in predicting adverse perinatal and maternal outcomes was then assessed using receiver-operating-characteristics (ROC)-curve analysis. Adverse maternal outcome was defined as one or more of severe hypertension, admission to the intensive care unit, eclampsia, placental abruption, HELLP syndrome, disseminated intravascular coagulation, platelets < 100 × 109/L, creatinine > 1.1mg/dl and alanine aminotransferase > 100 U/L. Adverse perinatal outcome was defined as one or more of preterm birth at or before 34 + 0 weeks, neonatal intensive care unit admission for > 48 h, respiratory distress syndrome, intraventricular haemorrhage, hypoxic ischemic encephalopathy, necrotizing enterocolitis, retinopathy of prematurity and confirmed foetal infection. We recruited 91 women with pre-eclampsia at a mean gestational age of 30.63 ±2.86 weeks. Women who had adverse maternal event had higher median maternal concentrations of sFlt (11500.0 pg/mL vs 3051.0 pg/mL; P < 0.001) and lower PlGF (44.88 pg/mL vs 148.50 pg/mL; P < 0.001) and a higher sFlt-1/PlGF ratio (306.22 vs 30.63; P < 0.001) compared to women who did not. Pregnancies with an adverse perinatal outcome also had a higher sFlt-1 (12100.0 pg/mL vs 3051.0 pg/mL; P < 0.001), lower PlGF (27.2 pg/mL vs 148.50 pg/mL; P < 0.001) and higher sFlt-1/PlGF ratio (378.45.4 vs 30.63; P < 0.001). Area under receiver operator curve shows sFlt and PlGF to emerge as best biomarkers compared from other biochemical markers to predict adverse maternal (AUC,0.81 (0.72–0.90) and foetal (AUC, 0.88 (0.80–0.96)) outcomes in PE. The sFlt-1/PlGF ratio correlates well in predicting adverse maternal and perinatal outcomes compared to any other biochemical marker in Indian population. The incorporation of the sFlt-1/PlGF ratio in women with preeclampsia can help in predicting the severity of the condition and timings of the delivery.

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