The Prognostic Value of Angiogenic Markers in Twin Pregnancies to Predict Delivery Due to Maternal Complications of Preeclampsia

Abstract

The sFlt-1 (soluble fms-like tyrosine kinase-1), PlGF (placental growth factor), and their ratio are useful for predicting delivery because of preeclampsia in singleton pregnancies. Evidence on the utility of sFlt-1/PlGF ratio in twin pregnancies is lacking. We aimed to evaluate the predictive value of sFlt-1/PlGF ratio for delivery because of preeclampsia in twins. A retrospective data analysis of 164 twin pregnancies with suspected preeclampsia was performed. The sFlt-1/PlGF ratio, which was known to clinicians, was significantly higher in women who delivered within 1 and 2 weeks compared with those who did not (median: 98.9 and 84.2 versus 23.5 pg/mL, respectively; P <0.001). The area under the curve values sFlt-1/PlGF ratio levels were 0.88 (95% CI, 0.83–0.84) and 0.88 (95% CI, 0.83–0.93) for predicting delivery because of preeclampsia within 1 and 2 weeks of blood sampling, respectively. The predictive accuracy of sFlt-1/PlGF was independent of gestational age at sampling and chorionicity ( P >0.100 for interaction). The area under the curve values of sFlt-1/PlGF were significantly higher than for PlGF alone (mean 0.88 and 0.88 versus 0.81 and 0.80) for predicting delivery because of preeclampsia within 1 and 2 weeks of blood sampling ( P =0.055 and 0.001, respectively). sFlt-1/PlGF ratio lower than 38 was able to rule-out delivery within 1 and 2 weeks with a negative predictive value of 98.8% and 96.4% for delivery because of preeclampsia within 1 and 2 weeks, respectively. A cutoff of 38 is applicable for ruling out delivery because of preeclampsia in twin pregnancies.

Gestational Age-Specific Reference Ranges for the sFlt-1/PlGF Immunoassay Ratio in Twin Pregnancies

“…Our exploratory prediction performance analysis indicates that using a cutoff of 38 for the sFlt-1/PlGF ratio has an NPV of 91.9 and 83.8% to rule out PE within 1 and 4 weeks, respectively, in women with twin pregnancies and suspected PE. This is in agreement with the study by Binder et al [31] which determined that using a cutoff of 38 for the sFlt-1/PlGF ratio has an NPV of 98.8 and 96.4% to rule out PE within 1 and 2 weeks, respectively. As failure to detect PE can have serious clinical implications, a very high NPV is crucial when assessing patients with suspected PE.…”

“…While we found no statistically significant differences in the sFlt-1/PlGF ratios between monochorionic and dichorionic twin pregnancies, in agreement with Binder et al [31], Faupel-Badger et al [9] suggest that monochorionic twin pregnancies have higher values of sFlt-1 and sFlt-1/PlGF ratios. This discrepancy may be due to the low number of cases in the study by Faupel-Badger et al [9] ( n = 5 monochorionic pregnancies; n = 36 dichorionic pregnancies).…”

The diagnostic value of angiogenic and antiangiogenic factors in differential diagnosis of preeclampsia

“…33 Recently, Binder et al 33 showed the applicability of the cutoff of 38 to rule out a delivery because of PE in twin pregnancies for 1 and 2 weeks at an NPV of 98.8% and 96.4%, respectively. 34 Following single measurements, repeated measurements are important: patients with a delta between 2 measurements 2 and 3 weeks apart have a higher risk of PE. In the group of women that eventually developed PE, the mean delta of the sFlt-1etoePlGF ratio within 2 weeks was 31.2 (interquartile range [IQR], 6.48e62.36), whereas in the group of patients that did not develop PE in the end, it was 1.45 (IQR e0.12 to 9.41).…”

Predicting hypertensive disorders in pregnancy using multiple methods: Models with the placental growth factor parameter

“…The main biological function of PlGF is to promote the formation of placental blood vessels [ 10 , 11 ]. PlGF is a kind of biomarker.…”

“…Bian et al used sFlt-1/PlGF ratio to predict the risk of preeclampsia in Asian women [ 10 ]. PlGF combined with other angiogenesis markers, such as sFlt-1, also had a certain prognostic value for preeclampsia [ 11 , 12 ]. There are also some controversies in related prediction research.…”