Angiogenic markers sFlt-1 and PIGF can be used to predict the course of early-onset preeclampsia

Angiogenic and antiangiogenic facors such as sFlt-1 and, respectively, PlGF play a major role in the pathogenesis of preeclampsia (PE) and can be used clinically as adjunct tests to diagnose PE in unclear cases. However, it is not known if these markers can predict the course of PE. For optimal management of patients with PE, such a test would be clinically useful, e.g. for indication of administration of antenatal glucocorticoids. The aim of this study was to investigate the correlation between the sFlt-1/PIGF-values and time to delivery (TTD), being a surrogate marker for the severity of the course of PE.

Material and methods: In this cohort study 57 patients with overt PE at admission were enrolled at the University Hospital of Bern between 2011 and 2014. sFlt-1 and PlGF were analysed in peripheral blood using the ROCHE Elecsys Test. We analysed the correlation between angiogenic markers and TTD, using TTD as surrogate marker for severe course of PE. The results of angiogenic factors were not used clinically for indication for delivery.

Results: No significant correlation between these angiogenic markers and TTD was found when all 57 cases were analysed (sFlt-1: spearman r =-0.16, p = 0.232; PLGF: spearman r = 0.007, p = 0.957; sFlt-1/PLGF ratio: spearman r =-0.086, p = 0.523). When we sub-stratified in early-onset PE and late-onset PE, however, we found a significant inverse correlation in the early-onset PE group (n = 44) for the sFlt-1/PLGF ratio (spearman r =-0.299, p = 0.048). The sFlt-1/PLGF ratio in patients with delivery prior to 48 H in this group of 44 patients were higher when compared with patients with delivery > 48 H, but without significance (< 48 H vs. > 48 H: 373.8 ± 67.31 vs. 362.2 ± 77.94, p = 0.916)

Discussion: In summary our data show that in patients affected by early-onset PE, the sFlt-1/PlGF ratio correlates inversely with TTD. We therefore propose that sFlt-1/PlGF can be used clinically to predict the course of the disease in patients with early-onset PE.