×
Home Current Archive Editorial board
News Contact
Review paper

The soluble fms-like tyrosin kinase-1 (sFLT-1) to placental growth factor (PIGF) ratio as a possible indicator for the severity of preeclampsia - single institution experience

By
Andrijana Müller Orcid logo ,
Andrijana Müller
Contact Andrijana Müller

Clinical Department of Gynaecology and Obstetrics, University Hospital Centre Osijek, Osijek, Croatia

School of Medicine, J.J. Strossmayer University, Osijek, Croatia

Vesna Horvat ,
Vesna Horvat

School of Medicine, J.J. Strossmayer University, Osijek, Croatia

Department of Medical Chemistry, Biochemistry and Clinical Chemistry, University Hospital Centre, Osijek, Croatia

Martina Vulin ,
Martina Vulin

Clinical Department of Gynaecology and Obstetrics, University Hospital Centre Osijek, Osijek, Croatia

School of Medicine, J.J. Strossmayer University, Osijek, Croatia

Sanja Mandić ,
Sanja Mandić

School of Medicine, J.J. Strossmayer University, Osijek, Croatia

Department of Medical Chemistry, Biochemistry and Clinical Chemistry, University Hospital Centre, Osijek, Croatia

Vatroslav Šerić ,
Vatroslav Šerić

School of Medicine, J.J. Strossmayer University, Osijek, Croatia

Department of Medical Chemistry, Biochemistry and Clinical Chemistry, University Hospital Centre, Osijek, Croatia

Domagoj Vidosavljević
Domagoj Vidosavljević
Contact Domagoj Vidosavljević

Clinical Department of Gynaecology and Obstetrics, University Hospital Centre Osijek, Osijek, Croatia

School of Medicine, J.J. Strossmayer University, Osijek, Croatia

Abstract

Aim
To investigate a potential of the clinical use of the soluble fms-like tyrosine kinase 1 (sFLT-1) to placental growth factor (PlGF) ratio from the perspective of a small hospital centre.
Methods
Maternal serum samples were analysed at 24 1/7-28 0/7 , and 28 1/7-32 0/7 weeks of gestation. The level of sFLT-1 and PIGF was determined by immunoassay platform and used to calculate the sFLT-1/PIGF ratio in 35 pregnant women, and divided into subgroups according to preeclampsia occurrence at the time of delivery: preterm (≤37 weeks) or term (37-42 weeks'), and matched a control group.
Results
Patients in the preterm delivery group had a significantly higher incidence of intrauterine growth restriction, lower gestational age at the time of delivery, and lower infant birth weight compared to the other two groups. There was a negative correlation between the sFLT-1/PlGF ratio and GA and between the sFLT-1/ PlGF ratio and birth weight at the time of delivery. The value of the sFLT-1/PlGF ratio was significantly higher in the preterm delivery PE group. All the PE group pregnancies ended with caesarean delivery compared to 25% in the control group. However, none of the patients from the PE group had any of the possible complications of preeclampsia nor did they require additional therapy such as blood transfusion or additional non-standard hypertensive therapy.
Conclusion
The sFLT-1/PlGF ratio could be used as an indicator for the development and estimation of the severity of PE to provide objective evidence for the management of preeclampsia patients, and as a predictive marker of preeclampsia at low cost.

References

1.
Hutcheon J, Lisonkova S, Joseph K. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol. 2011. p. 391–403.
2.
Roberts J, August P, Bakris G, Barton J, Bernstein I, Druzin M, et al. of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013. p. 1122–31.
3.
Phipps E, Prasanna D, Brima W, Jim. Preeclampsia: updates in pathogenesis, definitions, and guidelines. Clin J Am Soc Nephrol. 2016. p. 1102–13.
4.
Magee L, Von Dadelszen P. State-of-the-art diagnosis and treatment of hypertension in pregnancy. Mayo Clin Proc. 2018. p. 1664–77.
5.
Karumanchi S, Kee-Hak L, August P. Preeclampsia: pathogenesis.
6.
Kaufmann P, Black S, Huppertz B. Endovascular trophoblast invasion: implications for the pathogenesis of intrauterine growth retardation and preeclampsia. Biol Reprod. 2003. p. 1.
7.
Stepan H, Schaarschmidt W, Jank A, Verlohren S, Kratzsch J. Use of angiogenic factors (sFlt-1/PlGF ratio) to confirm the diagnosis of preeclampsia in clinical routine: first experience. Z Geburtshilfe Neonatol. 2010. p. 234–8.
8.
Maynard S, Min J, Merchan J, Lim K, Li J, Mondal S, et al. Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest. 2003. p. 649–58.
9.
Stepan H, Herraiz I, Schlembach D, Verlohren S, Brennecke S, Chantraine F, et al. Implementation of the sFlt-1/PlGF ratio for prediction and diagnosis of pre-eclampsia in singleton pregnancy: implications for clinical practice. Ultrasound Obstet Gynecol. 2015. p. 241–6.
10.
Herraiz I, Simon E, Gomez-Arriaga P, Martinez-Moratalla J, Garcia-Burguillo A, Jimenez E, et al. Angiogenesis-related biomarkers (sFlt-1/PLGF) in the prediction and diagnosis of placental dysfunction: an approach for clinical integration. Int J Mol Sci. 2015. p. 19009–26.
11.
Health and Care Excellence (database on internet) London, UK. PIGF-based testing to help diagnose suspected preeclampsia. 2016.
12.
Shibata E, Rajakumar A, Powers R, Larkin R, Gilmour C, Bodnar L. Soluble fms-like tyrosine kinase 1 is increased in preeclampsia but not in normotensive pregnancies with small-for-gestational-age neonates: relationship to circulating placental growth factor. J Clin Endocrinol Metab. 2005. p. 4895–903.
13.
Kim S, Ryu H, Yang J, Kim M, Han J, Kim J, et al. Increased sFlt-1 to PlGF ratio in women who subsequently develop preeclampsia. J Korean Med Sci. 2007. p. 873–7.
14.
Herraiz I, Llurba E, Verlohren S, Galindo A. Update on the diagnosis and prognosis of preeclampsia with the aid of the sFlt-1/ PlGF Ratio in singleton pregnancies. Fetal Diagn Ther. 2018. p. 81–9.
15.
Uzan J, Carbonnel M, Piconne O, Asmar R, Ayoubi J. Pre-eclampsia: pathophysiology, diagnosis, and management. Vasc Health Risk Manag. 2011. p. 467–74.
16.
Kleinrouweler C, Wiegerinck M, Ris-Stalpers C, Bossuyt P, Van Der Post J, Von Dadelszen P, et al. Accuracy of circulating placental growth factor, vascular endothelial growth factor, soluble fms-like tyrosine kinase 1 and soluble endoglin in the prediction of pre-eclampsia: a systematic review and meta-analysis. BJOG. 2012. p. 778–87.
17.
Chappell L, Duckworth S, Seed P, Griffin M, Myers J, Mackillop L. Diagnostic accuracy of placental growth factor in women with suspected preeclampsia: a prospective multicenter study. Circulation. 2013. p. 2121–31.
18.
Tan M, Wright D, Koutoulas L, Akolekar R, Nicolaides K. Comparison of screening for pre-eclampsia at 31-34 weeks’ gestation by sFlt-1/PlGF ratio and a method combining maternal factors with sFlt-1 and PlGF. Ultrasound Obstet Gynecol. 2017. p. 201–8.
19.
Lai J, Larroca GT, Peeva S, Poon G, Wright L, Nicolaides D, et al. Competing risks model in screening for preeclampsia by serum placental growth factor and soluble fms-like tyrosine kinase-1 at 30-33 weeks’ gestation. Fetal Diagn Ther. 2014. p. 240–8.
20.
Koopmans C, Bijlenga D, Groen H, Vijgen S, Aarnoudse J, Bekedam D, et al. HYPITAT study group. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): a multicentre, open-label randomised controlled trial. Lancet. 2009. p. 979–88.
21.
Klein E, Schlembach D, Ramoni A, Langer E, Bahlmann F, Grill S, et al. Influence of the sFlt-1/PlGF ratio on clinical decision-making in women with suspected preeclampsia. PLoS One. 2016. p. 156013.

Citation

Authors retain copyright. This work is licensed under a Creative Commons Attribution 4.0 International License. Creative Commons License

 

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.