Longitudinal assessment of angiogenic markers in prediction of adverse outcome in women with confirmed pre‐eclampsia

• Published in: Ultrasound in obstetrics & gynecology 2023-12, Vol.62 (6), p.843-851
• Main Authors: Binder, J., Palmrich, P., Kalafat, E., Haberl, C., Schirwani, N., Pateisky, P., Khalil, A.
• Format: Article
• Language: English
• Subjects: Accuracy; adverse maternal outcome; adverse perinatal outcome; Alanine; Alanine transaminase; Angiogenesis; angiogenic markers; Aspartate aminotransferase; Biomarkers; Creatinine; Diagnosis; Eclampsia; Edema; Enterocolitis; Female; Growth factors; Gynecology; Hemorrhage; Humans; Infant, Newborn; Intensive care; Kinases; L-Lactate dehydrogenase; Lactate dehydrogenase; longitudinal assessment; Necrotizing enterocolitis; Neonates; Obstetrics; Parameters; Performance prediction; Placenta; Placenta - metabolism; Placenta Growth Factor; placental growth factor; Platelets; Pre-Eclampsia; prediction; Prediction models; Predictive Value of Tests; Preeclampsia; Pregnancy; Protein-tyrosine kinase; Respiratory distress syndrome; Retrospective Studies; sFlt‐1/PlGF ratio; soluble fms‐like tyrosine kinase‐1; Surveillance; Transaminases; Tyrosine; Ultrasonic imaging; Ultrasound; Vascular Endothelial Growth Factor Receptor-1
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.26276

ABSTRACT Objectives Angiogenic marker assessment, such as the ratio of soluble fms‐like tyrosine kinase‐1 (sFlt‐1) to placental growth factor (PlGF), is known to be a useful tool in the prediction of pre‐eclampsia (PE). However, evidence from surveillance strategies in pregnancies with a PE diagnosis is lacking. Therefore, we aimed to assess the predictive performance of longitudinal maternal serum angiogenic marker assessment for both maternal and perinatal adverse outcomes when compared to standard laboratory parameters in pregnancies with confirmed PE. Methods This was a retrospective analysis of prospectively collected data from January 2013 to December 2020 at the Medical University of Vienna. The inclusion criteria were singleton pregnancy with confirmed PE and post‐diagnosis maternal serum angiogenic marker assessment at a minimum of two timepoints. The primary outcome was the predictive performance of longitudinal sFlt‐1 and PlGF assessment for adverse maternal and perinatal outcomes compared to conventional laboratory monitoring at the same time in pregnancies with confirmed PE. Composite adverse maternal outcome included intensive care unit admission, pulmonary edema, eclampsia and/or death. Composite adverse perinatal outcome included stillbirth, neonatal death, placental abruption, neonatal intensive care unit admission, intraventricular hemorrhage, necrotizing enterocolitis, respiratory distress syndrome and/or mechanical ventilator support. Results In total, 885 post‐diagnosis sFlt‐1/PlGF ratio measurements were obtained from 323 pregnant women with confirmed PE. For composite adverse maternal outcome, the highest standalone predictive accuracy was obtained using maternal serum sFlt‐1/PlGF ratio (area under the receiver‐operating‐characteristics curve (AUC), 0.72 (95% CI, 0.62–0.81)), creatinine (AUC, 0.71 (95% CI, 0.62–0.81)) and lactate dehydrogenase (LDH) levels (AUC, 0.73 (95% CI, 0.65–0.81)). Maternal platelet levels (AUC, 0.65 (95% CI, 0.55–0.74)), serum alanine aminotransferase (ALT) (AUC, 0.59 (95% CI, 0.49–0.69)) and aspartate aminotransferase (AST) (AUC, 0.61 (95% CI, 0.51–0.71) levels had poor standalone predictive accuracy. The best prediction model consisted of a combination of maternal serum LDH, creatinine levels and sFlt‐1/PlGF ratio, which had an AUC of 0.77 (95% CI, 0.68–0.85), significantly higher than sFlt‐1/PlGF ratio alone (P = 0.037). For composite adverse perinatal outcome, the highest standalone predictive accuracy wa