Elevated serum YKL-40 levels as a diagnostic and prognostic marker in the placenta accreta spectrum

Abstract

Objective: Placenta accreta spectrum (PAS) is an important problem with increasing cesarean section (CS) rates recently. There is still no serum marker for the diagnosis. We determined whether serum YKL-40 levels can be used in the diagnosis and prognosis of PAS. Materials and Methods: The study was conducted with 50 patients with a PAS diagnosis, 27 individuals without PAS, and 33 normal pregnant women. The operations (CS + placental bed suture, CS + excision of the lower segment, CS-hysterectomy) and for individuals who had the excision of the lower segment /CS-hysterectomy, the histopathological diagnoses (accreta, increta, percreta) were recorded. Serum YKL-40 levels were analyzed. Results: The individuals with PAS possessed significantly greater serum YKL-40 grades (p=0.001). The surgical interventions included 4 CS + excision of the lower segment, 9 CS + placental bed sutures, and 37 CS-hysterectomy. The histopathological outcomes of the individuals who had the excision of the lower segment, CS-hysterectomy and diagnosed 6, 9, and 26 patients with accreta, increta, and percreta, respectively. The accreta, increta, and percreta groups showed statistically significant different serum YKL-40 grades (p=0.001). The receiver operating characteristic analysis was performed to discriminate the cut-off serum YKL-40 level as 32.81 ng/mL with a sensitivity of 66% and specificity of 70.37%. The positive and negative predictive values of YKL-40 in the indicator of PAS were 80.5% and 52.8%, respectively. Conclusion: Elevated serum YKL-40 grades were correlated with the diagnosis and severity of PAS. If our findings are corroborated and elaborated by larger patient series, the YKL-40 levels should be used along with ultrasonography to construct a model identical to that used in aneuploidy screening.

An interpretation for Chinese expert consensus on how to manage pregnant women of advanced maternal age with scarred uterus

“…[40] (3) Serum biomarkers: Researchers from Turkey discovered that elevated serum YKL-40 level was correlated with diagnosis and severity of PAS. [41] To date, PAS-associated predictive biomarkers comprise alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), pregnancyassociated plasma protein A (PAPP-A), cell-free fetal DNA (cffDNA), angiogenic-related factors including placental growth factor (PLGF), vascular endothelial growth factor (VEGF) and soluble fms-like tyrosine kinase-1 (sFlt-1), placenta-specific mRNA, microRNA, NanoVelcro chips etc. The existing research is not clear yet on how to predict PAS severity through these biomarkers and not applicable in clinical practice.…”