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Q&A

Hypertension

Poster Session 4

(992) Plasma sFlt-1/PlGF ratio as MoM improves prediction of preeclampsia with severe features within two weeks

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:

Cut-off values of the ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) as preeclampsia biomarker vary with assay platforms. This study compares multiples of the median (MoM) of maternal plasma sFlt-1/PlGF ratio, sFlt-1, PlGF, and conventional clinical and laboratory values to predict preeclampsia with severe features (PSF)

Study Design: Secondary data analysis of a cohort study across 18 U.S. centers involving hospitalized hypertensive patients between 23-35 weeks' gestation. Receiver operating characteristic curve (ROC) analyses of maternal plasma biomarkers, highest systolic or diastolic blood pressures, and laboratory values were performed for the prediction of PSF. Their areas under the curve (AUC) were compared and quasi-Poisson regression models were done. Primary outcome: PSF within two weeks. Secondary outcomes: composite of severe adverse maternal outcomes (HELLP syndrome, placental abruption, eclampsia, DIC, and pulmonary edema) and composite of severe adverse neonatal outcomes [birthweight< 3rd percentile, very preterm birth (< 32 weeks) and fetal/neonatal death]

Results:

A total of 543 patients were included. ROC-derived cut-off of 11.5 MoM for sFlt-1/PlGF plasma ratio provided sensitivity (90.6%), specificity (76.9%), PPV (66%), NPV (94.3%) and accuracy for PSF (81.4%) akin to FDA-approved predictive values. This cut-off was used to compare cases (≥ cut-off) and controls (< cut-off). PSF within two weeks was observed in 66% of cases vs. 5.7% in controls (IRR: 1.001; p< 0.001). Higher proportion of cases developed composites of severe adverse maternal (IRR: 1.001; p=0.028) or neonatal outcomes (IRR: 1.002; p< 0.001) than controls (Table 1). The AUC of sFlt-1/PlGF plasma ratio in MoM (0.91) for PSF within two weeks was significantly higher (< 0.05 for all comparisons) than either plasma biomarker alone or any of the other parameters

Conclusion:

sFlt-1/PlGF plasma ratio ≥11.5 MoM among hospitalized, hypertensive patients prior to 35 weeks of gestation is independently associated with PSF within two weeks and severe adverse maternal or neonatal outcomes