Predictive performance of sFlt-1, PlGF and the sFlt-1/PlGF ratio for preeclampsia: A systematic review and meta-analysis
Luhan Zhang, Wenjing Li, Xiaolan Chi, Qi Sun, Yuanyuan Li, Weiwei Xing, Guifeng Ding
Abstract
BACKGROUND: It is difficult to evaluate whether monitoring serum sFlt-1, PlGF, or sFlt-1/PlGF in pregnant women who are suspected of having PE can significantly shorten the PE diagnosis time. OBJECTIVES: To estimate the accuracy of sFlt-1, PlGF and sFlt-1/PlGF in preeclampsia prediction. SEARCH STRATEGY: Databases including PubMed, Web of Science, Medline, CNKI, SinoMed, VIP Journal, and Wanfang Data were searched for eligible studies published until October 7, 2022. SELECTION CRITERIA: The research subjects were pregnant women with or without PE. The research types were case-control studies and cohort studies. This was an original study involving the detection of at least one of the following in the blood, serum or plasma: sFlt-1, PlGF, and sFlt-1/PlGF. DATA COLLECTION AND ANALYSIS: StataSE 16.0 was employed, using the Sen, Spe, PLR, and NLR to plot SROC, and subgroup analysis and meta-regression were conducted. MAIN RESULTS: Meta-analysis showed that the combined Sen of sFlt, PlGF and sFlt-1/PlGF was 0.79 (95 % CI: 0.68-0.87), 0.76 (95 % CI: 0.69-0.82), and 0.83 (95 % CI: 0.77-0.88), respectively; the Spe was 0.86 (95 % CI: 0.77-0.92), 0.83 (95 % CI: 0.78-0.88), and 0.88 (95 % CI: 0.82-0.92), respectively; and the AUC was 0.89, 0.87, and 0.92, respectively. It was found to be attributable to study design, literature quality, sample size, disease subtypes, and cut-off values by using subgroup analysis and meta-regression. CONCLUSIONS: The sFlt-1/PlGF ratio showed better predictive performance for preeclampsia than sFlt-1 or PlGF alone. However, the predictive value of the latter two cannot be ignored.This study highlights the performance of biomarkers in the diagnosis and prediction of PE, but that there is currently a lack of data to assess the value of using these biomarkers in clinical practice, and that the use of these biomarkers has not yet been shown to improve pregnancy outcomes.