Predictive values of various serum biomarkers in women with suspected preeclampsia: A prospective study

Abstract

Background Preeclampsia (PE) prediction has been shown to improve the maternal and fetal outcomes in pregnancy. We aimed to evaluate the PE prediction values of a series of serum biomarkers. Methods The singleton pregnant women (20–36 gestational weeks) with PE‐related clinical and/or laboratory presentations were recruited and had the blood drawn at their first visits. The following markers were tested with the collected serum samples: soluble fms‐like tyrosine kinase 1 (sFlt‐1), placental growth factor (PlGF), thrombomodulin (TM), tissue plasminogen activator inhibitor complex (tPAI‐C), complement factors C1q, B, H, glycosylated fibronectin (GlyFn), pregnancy‐associated plasma protein‐A2 (PAPP‐A2), blood urea nitrogen (BUN), creatinine (Cre), uric acid (UA), and cystatin C (Cysc). Results Of the 196 recruited subjects, 25% (n = 49) developed preeclampsia before delivery, and 75% remained preeclampsia negative (n = 147). The serum levels of sFlt‐1, BUN, Cre, UA, Cysc, and PAPP‐A2 were significantly elevated, and the PlGF level was significantly decreased in the preeclampsia‐positive patients. In the receiver operating characteristics (ROC) analyses, the area under the curves were listed in the order of decreasing values: 0.73 (UA), 0.67 (sFlt‐1/PlGF), 0.66 (Cysc), 0.65 (GlyFn/PlGF), 0.64 (PAPP‐A2/PlGF), 0.63 (BUN), 0.63 (Cre), and 0.60 (PAPP‐A2). The positive predictive values of these serum markers were between 33.1% and 58.5%, and the negative predictive values were between 80.9% and 89.5%. Conclusions The serum markers investigated in current study showed better performance in ruling out than ruling in PE. Absence of pre‐defined latency period between blood draw and the onset of PE limits the clinical utility of these markers.

Serum peptidomic screening identified circulating peptide biomarkers predictive for preeclampsia

“…The finding was further validated in an independent cohort with comparable accuracy, sensitivity and specificity. Furthermore, this three-peptide model yielded a significantly improved PPV of 73.1-85.3% compared with that of sFlt-1/PlGF ratio as predictive markers (32.4-38.0%), which was close to what was observed in our previous study (9). Therefore, our panel is more accurate in PE prediction with suspected patients and offers a feasible and efficient strategy for "rule-in" and "rule-out" high risk patients who may need extra clinical care.…”

“…For instance, the soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) has been proven to be effective in excluding PE with a negative predictive value (NPV) of 99.3%, although the PPV was still lower than 40% ( 7 ). Similar observation was made with renal function tests such as uric acid and cystatin C ( 9 ).…”

“…The enrollment criteria for women with suspected PE are described as follows ( 9 ). The recruited singleton pregnant women were at least 18 years old and between 20 and 36 gestational weeks (GWs).…”

Endothelial Dysfunction in Pregnancy Complications

“…There are more controversies concerning the predictive value of TM level assessment in pregnant women. Conflicting results in this field were obtained by Prochazka et al [ 57 ] and Wang et al [ 58 ], both of which do not consider measurement of TM clinically relevant in the prediction of PE.…”

Glycosylated Fibronectin as a wide-spectrum biomarker in pregnancy

“…Also, pre-eclampsia accounts for 25% of stillbirths and 25% of neonatal deaths. 7,8 Alterations of maternal serum glycosylated fibronectin (GlyFn) levels have been studied in preeclamptic patients.…”