Urinary sFlt-1 and PlGF as preeclampsia predictors: sFlt-1/creatinine ratio improves the prediction value

Giovanna Martín-Palumbo; Marta Duque Alcorta; Marta Pérez de Aguado; Eugenia Antolín; José Luis Bartha

doi:10.1016/j.ejogrb.2024.05.002

Urinary sFlt-1 and PlGF as preeclampsia predictors: sFlt-1/creatinine ratio improves the prediction value

Eur J Obstet Gynecol Reprod Biol. 2024 May 7:298:53-60. doi: 10.1016/j.ejogrb.2024.05.002. Online ahead of print.

Authors

Giovanna Martín-Palumbo¹, Marta Duque Alcorta², Marta Pérez de Aguado³, Eugenia Antolín³, José Luis Bartha⁴

Affiliations

¹ Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain. Electronic address: giovanna.martin@estudiante.uam.es.
² Division of Clinical Chemistry, La Paz University Hospital, Madrid, Spain.
³ Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain.
⁴ Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain; Obstetrics and Gynecology of the Autonomous University of Madrid, Director of the Maternal and Fetal Research Group, Fundación para la Investigación Biomédica, La Paz University Hospital, Madrid, Spain.

PMID: 38728842
DOI: 10.1016/j.ejogrb.2024.05.002

Abstract

Objectives: To evaluate the correlation between maternal serum and urinary soluble Fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) levels and to assess their potential value in preeclampsia and fetal growth restriction.

Study design: This case-control longitudinal prospective study was performed in 49 singleton pregnant women, divided into two clinical groups, low risk pregnancy (n = 23) and pregnancy complicated by preeclampsia (n = 26). Maternal serum and urinary sFlt-1 and PlGF levels were quantified by electrochemiluminescence. Every patient underwent an ultrasound for fetal biometry. Doppler assessment was done when estimated fetal weight was under the 10th centile. ROC curves were used to evaluate the predictive capability of serum and urinary angiogenic biomarkers and their ratios on preeclampsia. Linear regression was used to compare the values of serum and urinary sFlt-1 and PlGF and their ratios.

Results: Urine biomarkers were positively associated with their serum values, being the best associated urinary PlGF (R² = 0.73), which also showed the highest predictive capability of preeclampsia of urine biomarkers (AUC 0.866). The predictive capability of urinary sFlt-1 was much lower (AUC 0.640), but increased when adjusting by serum creatinine, a more precise parameter (AUC 0.863).

Conclusions: Urinary PlGF could be a lesser invasive alternative to circulating biomarkers to monitor pregnancies complicated with preeclampsia that need repeated controls of their pregnancy complication. Urinary sFlt-1 values need adjustment by serum creatinine to be reliable.

Keywords: Fetal growth restriction; Middle cerebral artery pulsatility index; Placental growth factor; Preeclampsia; Soluble Fms-like tyrosine kinase-1.