New study correlates sFlt-1/PIGF with disease severity in PE/HELLP Patients with a high sFlt-1/PIGF ratio show significantly increased risk for imminent delivery
03 November 2011
A new study now published in the American Journal of Obstetrics and Gynecology1 shows the ratio of angiogenic factors, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PIGF). This is the first published evidence that a high sFlt-1/PIGF ratio has potential relevance as a prognostic marker for patients with diagnosed preeclampsia (PE) or HELLP. In preeclampsia identifying women who are about to give birth prematurely, the marker might support health professionals for improved targeted risk stratification and rapid clinical management.
The international group of European researchers1 shows that a certain threshold value of the sFlt-1/PlGF ratio, tested on the fully automated Elecsys preeclampsia immunoassays, was associated with a 3.5-fold increased risk of imminent delivery in PE patients after 34 weeks gestation: A follow-up of 95 PE patients after 34 weeks of gestation linked the ratio of sFlt-1/PIGF with risk of imminent birth within the next seven days. Among them 16.7 % with sFlt 1/PIGF ratios above the third quartile were still pregnant after 48 hours, turning to none after seven days.
The study further demonstrates that sFlt-1/PIGF ratios can help differentiate between PE and other hypertensive disorders in pregnancy. Women with PE or HELLP had significantly higher sFlt 1/PIGF ratios than women with gestational hypertension, chronic hypertension or no hypertensive disorder (all p<0.001).
The research team tested sFlt 1/PIGF ratios on a fully automated cobas® immunoassay system from Roche with a true measure of disease severity, stressing its high sensitivity and specificity. Diagnosing PE/HELLP, and assessing disease severity and associated risk, based on the standard procedure (such as proteinuria and hypertension) might be challenging as they do not always correlate with underlying disease.
Preeclampsia and Eclampsia may occur in as many as 8% of pregnancies and remain a leading cause of maternal and fetal morbidity and mortality.2 The most recent official report from the UK Centre for Maternal and Child Enquiries (CMACE 2011) ranked PE as the second most common direct cause of maternal death, accounting for around 18% of direct maternal deaths between 2006-2008.3 A serum test that directly predicts an impending need for delivery, allowing targeted perinatal care, could offer huge clinical benefits as delivery is currently the only cure for PE.
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1) Verlohren S, Herraiz I, Lapaire O, et al. The sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders and its prognostic potential in preeclamptic patients. Am J Obstet Gynecol 2011;205:1.e1-1.e8.
2) Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009 Jun;33(3):130-7.
3) UK Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Conﬁdential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118(Suppl. 1):1–203. http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02847.x/pdf accessed 19 September 2011.