Angiogenic factors hold promise in triage of women with suspected pre-eclampsia
Measuring the ratio of the soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) improves the accuracy of identifying pre-eclampsia without changing admission rates, according to the results of a trial.
The trial assessed the utility of sFlt-1/PlGF ratio in 370 women presenting with suspected pre-eclampsia who were then randomly allocated to groups that did (n=186) and did not (n=184) reveal the result of the test to clinicians.
Researchers used a ratio cutoff of 38 to define low (≤38) and elevated risk (>38) of developing pre-eclampsia in the subsequent week. The primary outcome was hospitalization within 24 hours of the test, while secondary outcomes included development of pre-eclampsia and other adverse maternal–foetal outcomes.
Pre-eclampsia occurred in 85 women (23 percent) overall. The number of admissions did not significantly differ between the reveal and nonreveal groups (48 vs 60; p=0.192). All women who developed the pregnancy disorder in the reveal group were admitted within 7 days, as compared with 83 percent of those in the nonreveal group (p=0.038).
For predicting the development of pre-eclampsia within 7 days, the sFlt-1/PlGF ratio test yielded a sensitivity of 100 percent (95 percent CI, 85.8–100) and a negative predictive value (NPV) of 100 percent (97.1–100). In comparison, clinical practice alone achieved 83.3 percent (58.6–96.4) sensitivity and 97.8 percent (93.7–99.5) NPV.
The researchers also noted a trend towards reduced time to diagnosis of the pregnancy disorder when using the test. Taken together, the findings suggest that he sFlt-1/PlGF ratio test allows the correct triage and hospitalization of women with suspected pre-eclampsia without changing admission rates.