An sFlt-1:PlGF ratio of 38 or lower can be used to predict the short-term absence of preeclampsia in women in whom the syndrome is suspected clinically. (Funded by Roche Diagnostics.).

Background An imbalance in circulating angiogenic factors plays a central role in the pathogenesis of preeclampsia. Methods and Results We prospectively studied 616 women who were evaluated for suspected preeclampsia. We measured plasma levels of antiangiogenic soluble fms-like tyrosine kinase 1 (sFlt1) and proangiogenic placental growth factor (PlGF) at presentation, and examined for an association between sFlt1/PlGF ratio and subsequent adverse maternal and perinatal outcomes within 2 weeks. The median [25th–75th centile] sFlt1/PlGF ratio at presentation was elevated in participants who experienced any adverse outcome compared to those who did not (47.0 [15.5–112.2] versus 10.8 [4.1–28.6], p<0.0001). Among those presenting <34 weeks (N=167), the results were more striking (226.6 [50.4–547.3] versus 4.5 [2.0–13.5], p<0.0001), and the risk was markedly elevated when the highest sFlt1/PlGF ratio tertile was compared to the lowest (OR 47.8, 95% CI 14.6–156.6). Among participants presenting at <34 weeks, the addition of sFlt1/PlGF ratio to hypertension and proteinuria significantly improved the prediction for subsequent adverse outcomes (AUC=0.93 for hypertension, proteinuria, and sFlt1/PlGF versus AUC=0.84 for hypertension and proteinuria alone; P=0.001). Delivery occurred within two weeks of presentation in 86.0% of women with sFlt1/PlGF ratio ≥ 85 compared with 15.8% of women with sFlt1/PlGF ratio <85 (HR 15.2, 95% CI 8.0–28.7). Conclusions In women with suspected preeclampsia presenting at <34 weeks, circulating sFlt1/PlGF ratio predicts adverse outcomes occurring within two weeks. The accuracy of this test is substantially better than current approaches and may be useful in risk stratification and management. Additional studies are warranted to validate these findings.

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