Serum sFlt-1/PlGF ratio has better diagnostic ability in early- compared to late-onset pre-eclampsia

• Published in: Journal of perinatal medicine Vol. 47; no. 1; pp. 35 - 40
• Main Authors: Chuah, Theng Theng, Tey, Wan Shi, Ng, Mor Jack, Tan, Edward T.H., Chern, Bernard, Tan, Kok Hian
• Format: Journal Article
• Language: English
• Published: Germany De Gruyter 01.01.2019; Walter de Gruyter GmbH
• Subjects: Accuracy; Adult; angiogenic factors; anti-angiogenic factors; Asian Continental Ancestry Group - statistics & numerical data; Biomarkers - blood; Diagnostic tests; Female; Gestational Age; Growth factors; Humans; Medical diagnosis; Placenta Growth Factor - blood; pre-eclampsia; Pre-Eclampsia - blood; Pre-Eclampsia - diagnosis; Pre-Eclampsia - epidemiology; Predictive Value of Tests; Preeclampsia; Pregnancy; Prospective Studies; Risk Assessment - methods; ROC Curve; Sensitivity and Specificity; sFlt1/PlGF ratio; Singapore - epidemiology; Vascular Endothelial Growth Factor Receptor-1 - blood; Singapore; angiogenic factors; anti-angiogenic factors; pre-eclampsia; sFlt1/PlGF ratio; pregnancy
• ISSN: 0300-5577; 1619-3997
• DOI: 10.1515/jpm-2017-0288

Background To establish gestational specific cutoffs for the soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) ratio as a diagnostic tool for pre-eclampsia (PE) in an Asian population. Methods 82 subjects (48 PE patients and 34 controls) were recruited. sFlt-1 and PlGF were analysed on the Roche Cobas e411 analyzer and their ratio was calculated. Diagnostic performance was evaluated using receiver-operating characteristics (ROC) curves. Optimal cutoffs for sFlt-1/PlGF ratio were determined for different gestation phases. Results The most optimal cut-off for the study group is 32 with a sensitivity and specificity of 85.1% and 100% and Youden Index (J) of 0.85. Applying this cutoff for early-onset PE (EO-PE), sensitivity increased to 95.8% while specificity remains at 100% (J=0.96). However, for late onset PE (LO-PE), sensitivity decreases to 73.9% while specificity remains at 100% (J=0.74). Two cutoffs were further determined for EO-PE and LO-PE - the first focusing on high sensitivity; the second focusing on high specificity. For EO-PE, cutoff <17 yielded sensitivity of 100% and specificity of 94.4% (J=0.94) while cutoff ≥32 yielded sensitivity of 95.8% and specificity of 100% (J=0.95). For LO-PE, cutoff <22 has a sensitivity of 82.6% and a specificity of 91.7% (J=0.74) while cutoff ≥32 yielded sensitivity of 73.9% and specificity of 100% (J=0.74). Conclusion While our study found an overall cutoff at 32 regardless of gestation age, it has limited diagnostic accuracy for LO-PE in our study. Multiple cutoffs focusing on either high sensitivity or high specificity enhance the performance of the sFlt-1/PlGF ratio as a diagnostic tool for PE and contribute to the identification of women at risk of PE in our Asian region.