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Review article: Biomedical intelligence

Vol. 151 No. 2728 (2021)

The role of sFlt1/PlGF ratio in the assessment of preeclampsia and pregnancy-related hypertensive disorders

DOI
https://doi.org/10.4414/smw.2021.20533
Cite this as:
Swiss Med Wkly. 2021;151:w20533
Published
14.07.2021

Summary

Preeclampsia is a major cause of maternal and fetal morbidity and mortality. Early recognition of the disease may be challenging. Complications may precede the onset of clinical symptoms and medical intervention is often delayed. Moreover, in the absence of specific clinical signs, many patients will present symptoms mimicking the disease without ever being diagnosed with preeclampsia. This situation may, however, lead to medical interventions and cause unnecessary stress for the patient. For many years, research tried to evaluate the significance of serum biomarkers as early indicators of preeclampsia. Among many, the sFlt-1/PlGF ratio, given its performance, aroused the greatest interest. This article reviews current knowledge on the subject, focusing on a Swiss perspective.

References

  1. WHO. WHO Recommendations for Prevention and Treatment of Pre-Eclampsia and Eclampsia. Geneva: World health Organization; 2011.
  2. Simeoni U, Armengaud JB, Siddeek B, Tolsa JF. Perinatal Origins of Adult Disease. Neonatology. 2018;113(4):393–9. doi:.https://doi.org/10.1159/000487618
  3. Menzies J, Magee LA, Macnab YC, Ansermino JM, Li J, Douglas MJ, et al. Current CHS and NHBPEP criteria for severe preeclampsia do not uniformly predict adverse maternal or perinatal outcomes. Hypertens Pregnancy. 2007;26(4):447–62. doi:.https://doi.org/10.1080/10641950701521742
  4. Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al.; International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension. 2018;72(1):24–43. doi:.https://doi.org/10.1161/HYPERTENSIONAHA.117.10803
  5. Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF, et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004;350(7):672–83. doi:.https://doi.org/10.1056/NEJMoa031884
  6. Sotiriadis A, Hernandez-Andrade E, da Silva Costa F, Ghi T, Glanc P, Khalil A, et al.; ISUOG CSC Pre-eclampsia Task Force. ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia. Ultrasound Obstet Gynecol. 2019;53(1):7–22. doi:.https://doi.org/10.1002/uog.20105
  7. Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennström M, et al. Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia. N Engl J Med. 2016;374(1):13–22. doi:.https://doi.org/10.1056/NEJMoa1414838
  8. Verlohren S, Herraiz I, Lapaire O, Schlembach D, Zeisler H, Calda P, et al. New gestational phase-specific cutoff values for the use of the soluble fms-like tyrosine kinase-1/placental growth factor ratio as a diagnostic test for preeclampsia. Hypertension. 2014;63(2):346–52. doi:.https://doi.org/10.1161/HYPERTENSIONAHA.113.01787
  9. National Institute for Health and Care Excellence. PlGF-based testing to help diagnose suspected pre-eclampsia (Triage PlGF test, Elecsys immunoassay sFlt-1/PlGF ratio, DELFIA Xpress PlGF 1-2-3 test, and BRAHMS sFlt-1 Kryptor/BRAHMS PlGF plus Kryptor PE ratio) NICE Diagnostic Guidance (DG23), 2016.
  10. Surbek DHM, Baumann M, et al. Utilisation du test sFlt-1/PlGF dans le diagnostic de la pré-éclampsie. Avis d'expert N° 67. SSGO; 2019.
  11. Chappell LC, Duckworth S, Griffin M, Tarft H, Seed P, Redman CW, et al.; PELICAN study consortium. OS100. Plasma placental growth factor (PLGF) measurement in women presenting with suspected pre-eclampsia: the pelican study. Pregnancy Hypertens. 2012;2(3):233–4. doi:.https://doi.org/10.1016/j.preghy.2012.04.101
  12. Duhig KE, Myers J, Seed PT, Sparkes J, Lowe J, Hunter RM, et al.; PARROT trial group. Placental growth factor testing to assess women with suspected pre-eclampsia: a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial. Lancet. 2019;393(10183):1807–18. doi:.https://doi.org/10.1016/S0140-6736(18)33212-4
  13. McCarthy FP, Gill C, Seed PT, Bramham K, Chappell LC, Shennan AH. Comparison of three commercially available placental growth factor-based tests in women with suspected preterm pre-eclampsia: the COMPARE study. Ultrasound Obstet Gynecol. 2019;53(1):62–7. doi:.https://doi.org/10.1002/uog.19051
  14. von Dadelszen P, Payne B, Li J, Ansermino JM, Broughton Pipkin F, Côté AM, et al., PIERS Study Group. Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model. Lancet. 2011;377(9761):219–27. doi:.https://doi.org/10.1016/S0140-6736(10)61351-7
  15. Rana S, Schnettler WT, Powe C, Wenger J, Salahuddin S, Cerdeira AS, et al. Clinical characterization and outcomes of preeclampsia with normal angiogenic profile. Hypertens Pregnancy. 2013;32(2):189–201. doi:.https://doi.org/10.3109/10641955.2013.784788
  16. Rana S, Powe CE, Salahuddin S, Verlohren S, Perschel FH, Levine RJ, et al. Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia. Circulation. 2012;125(7):911–9. doi:.https://doi.org/10.1161/CIRCULATIONAHA.111.054361
  17. Verlohren S, Herraiz I, Lapaire O, Schlembach D, Moertl M, Zeisler H, 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. 2012;206(1):58.e1–8. doi:.https://doi.org/10.1016/j.ajog.2011.07.037
  18. Tasta O, Parant O, Hamdi SM, Allouche M, Vayssiere C, Guerby P. Evaluation of the Prognostic Value of the sFlt-1/PlGF Ratio in Early-Onset Preeclampsia. Am J Perinatol. 2020. doi:.https://doi.org/10.1055/s-0040-1709696
  19. Duhig KE, Seed PT, Placzek A, Sparkes J, Hendy E, Gill C, et al. Prognostic indicators of severe disease in late preterm pre-eclampsia to guide decision making on timing of delivery: The PEACOCK study. Pregnancy Hypertens. 2021;24:90–5. doi:.https://doi.org/10.1016/j.preghy.2021.02.012
  20. Stepan H, Herraiz I, Schlembach D, Verlohren S, Brennecke S, Chantraine F, et al. Implementation of the sFlt-1/PlGF ratio for prediction and diagnosis of pre-eclampsia in singleton pregnancy: implications for clinical practice. Ultrasound Obstet Gynecol. 2015;45(3):241–6. doi:.https://doi.org/10.1002/uog.14799
  21. Cheng YKY, Poon LCY, Shennan A, Leung TY, Sahota DS. Inter-manufacturer comparison of automated immunoassays for the measurement of soluble FMS-like tyrosine kinase-1 and placental growth factor. Pregnancy Hypertens. 2019;17:165–71. doi:.https://doi.org/10.1016/j.preghy.2019.06.004
  22. Rodríguez-Almaraz ME, Herraiz I, Gómez-Arriaga PI, Vallejo P, Gonzalo-Gil E, Usategui A, et al. The role of angiogenic biomarkers and uterine artery Doppler in pregnant women with systemic lupus erythematosus or antiphospholipid syndrome. Pregnancy Hypertens. 2018;11:99–104. doi:.https://doi.org/10.1016/j.preghy.2018.01.008
  23. Hendrix M, Bons J, van Haren A, van Kuijk S, van Doorn W, Kimenai DM, et al. Role of sFlt-1 and PlGF in the screening of small-for-gestational age neonates during pregnancy: A systematic review. Ann Clin Biochem. 2020;57(1):44–58. doi:.https://doi.org/10.1177/0004563219882042
  24. Hodel M, Blank PR, Marty P, Lapaire O. sFlt-1/PlGF Ratio as a Predictive Marker in Women with Suspected Preeclampsia: An Economic Evaluation from a Swiss Perspective. Dis Markers. 2019;2019:4096847. doi:.https://doi.org/10.1155/2019/4096847

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