LAUSR

Objective: To assess whether a single determination of the serum values of sFlt-1, PlGF and their ratio improves prediction of delivery and maternal and foetal complications in women with suspected or clinically confirmed preeclampsia. Design and method: In this prospective, multicentre, observational study the plasma levels of antiangiogenic soluble fms-like tyrosine kinase 1 (sFlt-1) and proangiogenic placental growth factor (PlGF) were measured in women with (suspected) preeclampsia. Multivariable logistic regression analysis was used to assess the added value of sFlt-1, PlGF and their ratio to the traditional criteria, including gestational age, parity, blood pressure, proteinuria, uric acid, alanine aminotransferase and platelets, to estimate the risk of delivery and maternal and foetal complications. Models were compared using concordance (C)-statistic and R2. Results: Six hundredtwenty women (age 18 to 48 yrs., singleton pregnancies, median pregnancy duration 34 weeks (range 20–41 weeks) were included. Complications occurred in 118 (19%) of the women and in 248 (40%) of the neonates. Adding PlGF or the sFlt-1/PlGF ratio to the traditional criteria strongly predicted faster delivery, both resulting in R2 increases of 40%, whereas sFlt-1 alone increased the R2 by only 17%. The predictive value of maternal complications improved by adding sFlt-1, PlGF or the ratio to the traditional criteria, resulting in an increase of the C-statistic by respectively 0.080, 0.065 and 0.090 (from 0.746 to 0.826, 0.811 and 0.836, respectively). The incorporation of sFlt-1, PlGF and their ratio to the traditional criteria also resulted in an increase of the c-statistic for the foetal complications, by respectively 0.032, 0.053 and 0.04 (from 0.764 to 0.796, 0.817 and 0.812). Conclusions: sFlt-1, PlGF and their ratio have additive predictive value on top of the traditional criteria for both maternal and foetal complications, while PlGF and the ratio, but not sFlt-1 alone, help to predict faster delivery.