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Hypertension

Poster Session 4

(993) Plasma sFlt-1/PlGF ratio in MoM and Severe Adverse Neonatal Outcomes in Non-preeclamptic Patients

Wednesday, February 14, 2024

1:00 PM – 2:30 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Jimmy Espinoza, MD, MSc (he/him/his)

Professor
McGovern Medical School at the University of Texas Health Science Center Houston, The Fetal Center- Children’s Memorial Hermann Hospital
Houston, TX, United States

Coauthor(s)

VC

Vinicius Calsavara, PhD

Research Scientist I - Statistician
Cedars-Sinai Health System
Los Angeles, CA, United States
Elizabeth Lemoine, MD (she/her/hers)

Dr. Elizabeth Lemoine
University of North Carolina
Durham, NC, United States
SK

Sarah Kilpatrick, MD,PhD

Cedars-Sinai Medical Center
Los Angeles, CA, United States
RT

Ravi Thadhani, MD, MPH

Professor of Medicine with Tenure, Emory School of Medicine; Executive Director, Woodruff Health Sciences Center; Vice Chair of the Board, Emory Healthcare; Executive Vice President for Health Affairs
Emory University
Atlanta, GA, United States
S. Ananth Karumanchi, MD

Professor of Medicine; Medallion Chair, Vascular Biology
Cedars-Sinai Medical Center
Los Angeles, CA, United States

Objective: The adoption of ever-changing clinical criteria to diagnose preeclampsia has hindered progress in the prevention of adverse maternal and neonatal outcomes associated with it. This study compares the ratio of maternal plasma soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF), sFlt-1 or PlGF alone, and conventional clinical or laboratory values in the prediction of adverse perinatal outcomes in hospitalized patients with the suspicion of preeclampsia

Study Design: Secondary data analysis of a cohort study across 18 U.S. centers involving hospitalized hypertensive patients between 23-35 weeks' gestation. Areas under the curve (AUC) of multiple of the median (MoM) values of maternal plasma sFlt-1/PlGF ratio, maternal plasma sFlt-1 or PlGF alone, highest systolic or diastolic blood pressures, and laboratory values were compared for the prediction of severe adverse neonatal outcomes [birthweight< 3^rd percentile, very preterm birth (< 32 weeks) and fetal/neonatal death]. Quasi-Poisson regression models were done to determine the value of sFlt-1/PlGF ratio in MoM for the prediction of adverse perinatal outcomes adjusted for clinical or laboratory values

Results: A total of 330 hypertensive patients whose diagnosis of preeclampsia was not confirmed were included. The AUC of sFlt-1/PlGF plasma ratio in MoM (0.73) for the prediction of severe adverse perinatal outcomes was modest but it was significantly higher than highest systolic (0.60, p=0.01) or diastolic blood pressures (0.58, p=0.002), platelet count (0.59, p=0.04), and creatinine (0.59, p=0.01), AST, or ALT (both 0.53, p=0.001) concentrations. However, the AUC of sFlt-1/PlGF plasma ratio in MoM was similar than that of sFlt-1 (0.71) or PlGF (0.73) alone in the prediction of study outcomes. Regression analysis demonstrated that sFlt-1/PlGF ratio in MoM is independently associated with severe adverse perinatal outcomes (IRR: 1.002; 95^%CI: 1.001-1.003; p< 0.001)

Conclusion: Angiogenic imbalances is associated with severe adverse perinatal outcomes even if the diagnosis of preeclampsia is not confirmed