Biomarkers and the Prediction of Adverse Outcomes in Preeclampsia: A Systematic Review and Meta-Analysis

Lim, Siak Piang; Li, W.; Kemper, James M.; Nguyen, Andrew; Mol, Ben W J; Reddy, Maya

doi:10.1097/01.aoa.0000796084.31545.b9

Cited by 15 publications

(22 citation statements)

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“…In a meta‐analysis of 33 studies, we recently showed that the sFlt‐1/PlGF ratio may be useful in predicting adverse maternal and perinatal outcomes in women with PE (summary AUC, 0.79 (95% CI, 0.75–0.82)) 12 . In a recent ‘real‐world’ study of 1117 women, the sFlt‐1/PlGF ratio also demonstrated a reasonable performance in predicting adverse maternal and perinatal outcomes (AUC, 0.86), and the addition of the sFlt‐1/PlGF ratio to routinely collected clinical information significantly improved prognostic performance 39 .…”

Section: Discussionmentioning

confidence: 99%

“…They do not recommend the use of these markers to guide management in those with confirmed PE. However, emerging evidence suggests that these biomarkers may have a role in disease prognostication and, therefore, the management of women with confirmed PE 12,39 .…”

Section: Clinical and Research Implicationsmentioning

confidence: 99%

“…There is increasing evidence to support the use of biochemical markers such as placental growth factor (PlGF) and soluble fms‐like tyrosine kinase‐1 (sFlt‐1), to predict PE in the asymptomatic population and rule out the development of PE in those with suspected disease 9–11 . In a recently published systematic review, the sFlt‐1/PlGF ratio also performed well in predicting adverse maternal and perinatal outcomes in women with PE (area under the receiver‐operating‐characteristics curve (AUC), 0.79 (95% CI, 0.75–0.82)) 12 . However, in that review, most studies assessed a composite outcome, and it is uncertain whether this performance was driven by maternal outcome, perinatal outcome or both.…”

Section: Introductionmentioning

confidence: 99%

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Role of placental, fetal and maternal cardiovascular markers in predicting adverse outcome in women with suspected or confirmed pre‐eclampsia

Reddy

Palmer

Rolnik

et al. 2022

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?In this prospective cohort study, we have demonstrated that, in women with suspected or confirmed pre-eclampsia, the soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio performs well in predicting adverse perinatal outcome but not in predicting adverse maternal outcome. The use of maternal cardiovascular and fetal indices in addition to sFlt-1/PlGF ratio does not improve prognostic performance. What are the clinical implications of this work?There is a potential role for the sFlt-1/PlGF ratio in clinical practice, in which it may be used to stratify women with suspected or confirmed pre-eclampsia according to perinatal risk. However, given that this marker performs poorly in predicting maternal complications, its role in the management of women with diagnosed pre-eclampsia remains unclear.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical and Research Implicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of placental, fetal and maternal cardiovascular markers in predicting adverse outcome in women with suspected or confirmed pre‐eclampsia

Reddy

Palmer

Rolnik

et al. 2022

Ultrasound in Obstet & Gyne

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“…Preeclampsia has serious consequences for both the mother and fetus, but there is still no effective way to predict and prevent it. Placental growth factor and a soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio have been applied as major biomarkers for prediction of preeclampsia and indicating a poor prognosis for preeclampsia, but clinical usefulness is limited due to differences between several studies [22]. Several previous studies reported that vitamin D deficiency was related to the onset of preeclampsia.…”

Section: Discussionmentioning

confidence: 99%

Serum Vitamin D Biomarkers in Pregnant Women with Preeclampsia: A Prospective Pilot Study

Cho¹,

Jo²,

Jo³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Background: It has been suggested that hypovitaminosis D is associated with the development of preeclampsia. This study aimed to study the relationship between preeclampsia and various vitamin D serum biomarkers including 25-hydroxyl vitamin D [25(OH)D], vitamin D-binding protein (VDBP), and bioavailable and free 25(OH)D. Methods: This prospective study was conducted with 17 patients with preeclampsia and 38 normal pregnant women as the control group. Total serum 25(OH)D and VDBP concentrations were measured. The levels of bioavailable 25(OH)D and free 25(OH)D were also calculated. Two single nucleotide polymorphisms (rs4588 and rs7041) of the GC gene encoding VDBP were analyzed. Results: VDBP was significantly increased in the preeclampsia group compared to the normal pregnancy group (454.2 vs. 403.4 ng/mL; p = 0.036). When the preeclampsia patients were analyzed by dividing them into early-onset and late-onset, there was no significant difference in the serum vitamin D biomarkers levels. Also, when preeclampsia patients were classified into three subgroups of <2 days, 2-7 days, and >7 days from diagnosis to delivery, free 25(OH)D concentrations were significantly increased in the 2-7 days subgroup compared to the other subgroups (3.5 vs. 6.6 vs. 3.1 pg/mL; p = 0.032). The GC genotype and allele frequency showed no statistically significant different distribution between the preeclampsia and normal pregnancy groups. Conclusions: In the present study, the serum VDBP levels were significantly higher in the patients with preeclampsia than in the normal pregnancy group. Thus, among various serum vitamin D biomarkers, increased VDBP could be associated with the onset and pathogenesis of preeclampsia.

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“…Medicine ® OPEN improve the prediction of early-onset PE, and both this ratio and placental growth factor ratio alone show prognostic promise for adverse outcomes in PE. [10,11] However, the association between adverse pregnancy outcomes and serum levels of isolated antiangiogenic factors and acute-phase proteins remains unknown.…”

Section: Observational Studymentioning

confidence: 99%

Association of sFlt-1 and C-reactive protein with outcomes in severe preeclampsia

Nóbrega¹,

Katz²,

Lippo³

et al. 2022

Medicine

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To determine the association between soluble FMS-like tyrosine kinase-1 (sFlt-1) and high-sensitivity C-reactive protein (hs-CRP) with maternal and perinatal outcomes in patients with preeclampsia (PE) with severe features.A cohort study was conducted on 100 patients, 60 with PE with severe features, and 40 healthy women in the third trimester of pregnancy. Admission serum levels of sFlt-1 and hs-CRP and clinical and epidemiological parameters were evaluated to quantify the predictive ability of adverse maternal and perinatal outcomes using hierarchical multiple regression and receiver operating characteristic curves.Compared to controls, patients with PE and severe features had significantly higher levels of sFlt-1 but not hs-CRP. sFlt-1 and hs-CRP proved to be reasonable parameters for the prediction of composite adverse maternal outcomes. However, we found no correlation between these 2 biomarkers. PE integrated estimate of risk scores were correlated only with sFlt-1 levels. Regarding fetal outcomes, unlike hs-CRP, sFlt-1 was strongly associated with birth weight and Apgar score <7 at 5 minutes. Following multivariate analysis, maternal age, previous hypertension, sFlt-1, and hs-CRP levels remained independently associated with composite adverse maternal outcomes.sFlt-1 levels were elevated in patients with PE and severe features. Both sFlt-1 and hs-CRP may predict composite adverse maternal outcomes but do not correlate with each other and differ in perinatal morbidity patterns. These data support the hypothesis that the varied outcomes in PE may result from different pathogenic pathways.Abbreviations: AUC = area under the curve, BMI = body mass index, CI = confidence interval, FullPIERS = preeclampsia integrated estimate of risk, hs-CRP = high-sensitivity C-reactive protein, OR = odds ratio, PE = preeclampsia, sFLt-1 = soluble FMSlike tyrosine kinase-1.

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Biomarkers and the Prediction of Adverse Outcomes in Preeclampsia: A Systematic Review and Meta-Analysis

Cited by 15 publications

References 0 publications

Role of placental, fetal and maternal cardiovascular markers in predicting adverse outcome in women with suspected or confirmed pre‐eclampsia

Role of placental, fetal and maternal cardiovascular markers in predicting adverse outcome in women with suspected or confirmed pre‐eclampsia

Serum Vitamin D Biomarkers in Pregnant Women with Preeclampsia: A Prospective Pilot Study

Association of sFlt-1 and C-reactive protein with outcomes in severe preeclampsia

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