Prediction using serum glycosylated fibronectin of imminent pre‐eclampsia in women with new‐onset hypertension

Abstract

ObjectiveTo compare the predictive performance for delivery with pre‐eclampsia (PE) within 2 weeks after assessment in women with new‐onset hypertension at 24–41 weeks' gestation between serum glycosylated fibronectin (GlyFn) concentration, serum placental growth factor (PlGF) concentration and soluble fms‐like tyrosine kinase‐1 (sFlt‐1) to PlGF concentration ratio.MethodsThis was a prospective observational study of 409 women with a singleton pregnancy presenting at 24–41 weeks' gestation with new‐onset hypertension. The recommended cut‐off for sFlt‐1/PlGF ratio for the prediction of PE in the platform used in this study is 85; the appropriate cut‐offs for GlyFn and PlGF were determined to achieve the same screen‐positive rate as that of sFlt‐1/PlGF ratio > 85. We then compared the predictive performance for delivery with PE within 2 weeks after presentation between GlyFn, PlGF and sFlt‐1/PlGF, both overall and in subgroups according to gestational age at presentation.ResultsDelivery with PE within 2 weeks occurred in 93 (22.7%) cases. The screen‐positive rate for sFlt‐1/PlGF ratio > 85 was 46.2%. The cut‐off corresponding to a screen‐positive rate of 46.2% was 75 pg/mL for PlGF and 510 µg/mL for GlyFn. The overall detection rate for delivery with PE within 2 weeks after presentation was 62.4% (95% CI, 51.7–72.2%) for GlyFn and sFlt‐1/PlGF and 60.2% (95% CI, 49.5–70.2%) for PlGF. In all women who delivered with PE within 2 weeks after presentation at < 34 weeks' gestation and in about 60–70% of those presenting at < 38 weeks, GlyFn and sFlt‐1/PlGF were increased and PlGF was reduced. However, the screen‐positive rate for these tests was very high at about 45%. The predictive performance for delivery with PE within 2 weeks after presentation at ≥ 38 weeks' gestation was poorer for all three methods of screening, with detection rates of 47–63% at screen‐positive rates of 40–50%.ConclusionsIn women with new‐onset hypertension, the predictive performance for delivery with PE within 2 weeks after presentation for serum GlyFn is similar to that of PlGF and the sFlt‐1/PlGF ratio, but GlyFn may be the preferred option because it is a rapid point‐of‐care test. However, the predictive performance for all tests is relatively poor. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Prediction using serum glycosylated fibronectin and angiogenic factors of superimposed pre‐eclampsia in women with chronic hypertension

“…In a previous study of women presenting with new‐onset hypertension at 24–41 weeks' gestation, we found that the predictive performance for delivery with PE within 2 weeks of presentation by GlyFn was similar to that of PlGF and the sFlt‐1/PlGF ratio, with a detection rate of about 60% at a screen‐positive rate of 46% and a false‐positive rate of 42% 17 . Although the screen‐positive and false‐positive rates in the women with new‐onset hypertension were much higher than those reported herein in women with chronic hypertension, the predictive performance in the two patient groups is similar, because, as shown in the ROC curves in Figure 2, the detection rate of superimposed PE by GlyFn in women with chronic hypertension is about 75%, at a false‐positive rate of 42%.…”

“…First, we examined the distribution of GlyFn concentration, PlGF concentration and sFlt-1/PlGF concentration ratio in the group of women who developed superimposed PE and those that did not. Second, we defined screen-positive groups using the recommended cut-off of 85 for the sFlt-1/PlGF ratio 24 and, to allow for comparison, cut-offs of 75 pg/mL for PlGF and 510 μg/mL for GlyFn were used, as described previously 17 . We found great disparity between the three tests in screen-positive rates so, to allow for a fair comparison between the tests, we found the cut-off for each test corresponding to a screen-positive rate of approximately 10%.…”

“…More recently, GlyFn has been proposed as a useful biomarker in the prediction of imminent PE in women presenting with signs and symptoms of the disease 15,16 . However, in a study of 409 women with a singleton pregnancy presenting with new-onset hypertension at 24-41 weeks' gestation, we found that the predictive performance for delivery with PE within 2 weeks of presentation, which occurred in 23% of cases, was poor; GlyFn performed similarly to PlGF and the sFlt-1/PlGF ratio, with a detection rate of about 60% at a screen-positive rate of 46% and a false-positive rate of 42% 17 .…”

“…Table 3 Predictive performance for superimposed pre-eclampsia in women with chronic hypertension, using predefined cut-offs 17…”

Screening for pre‐eclampsia by maternal serum glycosylated fibronectin and angiogenic markers at 36 weeks' gestation

“…In previous studies in women with chronic hypertension and in those presenting to specialist clinics with GH, we reported that the predictive performance for development of PE within the subsequent 2 weeks of serum GlyFn concentration was similar to that of PlGF concentration and sFlt‐1/PlGF concentration ratio 26,27 . However, the performance of all three tests was poor and their use is unlikely to improve the management of such women.…”