The additive role of angiogenic markers for women with confirmed preeclampsia

Suresh, Sunitha C.; Patel, Easha; Mueller, Ariel; Morgan, James I.; Lewandowski, Whitney Lynn; Verlohren, Stefan; Dadelszen, Peter von; Magee, Laura A.; Rana, Sarosh

doi:10.1016/j.ajog.2022.10.044

Cited by 13 publications

(19 citation statements)

References 31 publications

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“…presence of symptoms, laboratory results, ultrasound and Doppler measurements) increases the detection of adverse outcomes in women with suspected disease [16 ▪▪ ]. Several other studies have confirmed the outstanding performance of these biomarkers [16 ▪▪ ,23,37–42]. Their ability to appropriately ‘rule out’ and ‘rule in’ preeclampsia enables individualized management with increased follow up for high-risk women, appropriate reassurance for those at low risk and consequent appropriate allocation of resources.…”

Section: Novel Diagnostic Approachesmentioning

confidence: 98%

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Novel therapeutic and diagnostic approaches for preeclampsia

Vatish

Powys

Cerdeira

2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewThis review will summarize recent findings relating to the diagnostic approach to preeclampsia and current avenues of research aimed at modifying the underlying disease process. Recent findingsGrowing international consensus supports a broad preeclampsia definition that incorporates maternal endorgan and uteroplacental dysfunction. Recent evidence demonstrates that this definition better identifies women and babies at risk of adverse outcomes compared to the traditional definition of hypertension and proteinuria. Multiple studies have demonstrated the usefulness and cost-effectiveness of angiogenic biomarkers such as soluble fms-like tyrosine kinase-1 and placental growth factor as a clinical adjunct to diagnose and predict severity of preeclampsia associated outcomes. Current novel therapeutic approaches to preeclampsia target pathogenic pathways (e.g. antiangiogenesis) or downstream effects such as oxidative stress and nitric oxide. Recent findings relating to these promising candidates are discussed. Multicenter clinical trials are needed to evaluate their effectiveness and ability to improve fetal and maternal outcomes.

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Section: Novel Diagnostic Approachesmentioning

confidence: 98%

“…Rather, these tests are used as an adjunct to assist the clinician to come to an informed decision. Of note, a broad definition of PE in addition to angiogenic biomarkers best identifies adverse maternal and fetal outcomes [11 ▪▪ ,36 ▪▪ ,42].…”

Section: Novel Diagnostic Approachesmentioning

confidence: 99%

Novel therapeutic and diagnostic approaches for preeclampsia

Vatish

Powys

Cerdeira

2023

Current Opinion in Nephrology &Amp; Hypertension

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“…Given that preeclampsia with severe features in general results in more significant morbidity compared to lesser HDP, utilizing biomarkers may help aid clinicians in triaging patients to more aggressive therapy and monitoring or outpatient management. A cohort study in the United States investigated the predictive value of sFlt-1/PlGF among patients presenting to obstetrical triage for preeclampsia evaluation ( 77 ). A ratio of >38 in patients with suspected preeclampsia and patients diagnosed with preeclampsia without severe features while in triage was predictive of the development of preeclampsia with severe features within 2 weeks of presentation (OR 15.6%, confidence interval 8.91–27.40 for restrictive diagnosis, and OR 14.56% with 95% confidence interval 8.30–25.56 for broader diagnosis) ( 77 ).…”

Section: Prediction Of Preeclampsia and Related Adverse Outcomesmentioning

confidence: 99%

“…A cohort study in the United States investigated the predictive value of sFlt-1/PlGF among patients presenting to obstetrical triage for preeclampsia evaluation ( 77 ). A ratio of >38 in patients with suspected preeclampsia and patients diagnosed with preeclampsia without severe features while in triage was predictive of the development of preeclampsia with severe features within 2 weeks of presentation (OR 15.6%, confidence interval 8.91–27.40 for restrictive diagnosis, and OR 14.56% with 95% confidence interval 8.30–25.56 for broader diagnosis) ( 77 ). Similarly, another large study assessed the value of sFlt-1/PlGF in predicting progression to preeclampsia with severe features and identifying those at the highest risk of adverse maternal outcomes ( 78 ).…”

Section: Prediction Of Preeclampsia and Related Adverse Outcomesmentioning

confidence: 99%

Preeclampsia pathophysiology and adverse outcomes during pregnancy and postpartum

et al. 2023

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BackgroundPreeclampsia is a disease with far-reaching consequences that extend beyond the immediate postpartum period and have a significant impact later in life. Preeclampsia exerts an effect on most organ systems in the body. These sequelae are mediated in part by the incompletely elucidated pathophysiology of preeclampsia and the associated vascular changes.ContentCurrent research focuses on unraveling the pathophysiology of preeclampsia with the goal of implementing accurate screening and treatment modalities based on disease development and progression. Preeclampsia causes significant short- and long-term maternal morbidity and mortality, not only in the cardiovascular system but also in other organ systems throughout the body. This impact persists beyond pregnancy and the immediate postpartum period.SummaryThe goal of this review is to discuss the current understanding of the pathophysiology of preeclampsia as it relates to the adverse health consequences in patients impacted by this disease, along with a brief discussion of ways to improve overall outcomes.

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“…Suresh et al 36 demonstrated that an elevated sFlt-1/PlGF ratio > 85 best predicted adverse maternal outcome at triage in women with suspected PE. In contrast to our findings, sFlt-1/PlGF ratio failed to improve diagnostic test value for perinatal adverse events in women with confirmed PE, which might be due to the small number of fetal adverse events, the smaller proportion of women presenting with a sFlt-1/PlGF ratio > 85 (17%) or lack of longitudinal assessment in their cohort.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Longitudinal assessment of angiogenic markers in prediction of adverse outcome in women with confirmed pre‐eclampsia

Binder

Palmrich

Kalafat

et al. 2023

Ultrasound in Obstet & Gyne

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ObjectivesAngiogenic marker assessment such as the ratio of soluble fms‐like tyrosine kinase 1 (sFlt‐1) to placental growth factor (PlGF), is known to be a useful tool in the prediction of pre‐eclampsia. However, evidence on surveillance strategies in pregnancies with pre‐eclampsia diagnosis is lacking. Therefore, we aimed to assess the predictive performance of longitudinal maternal serum angiogenic marker assessment for adverse maternal and perinatal outcomes compared to standard laboratory parameters in pregnancies with confirmed pre‐eclampsia.MethodsThis was a retrospective analysis of prospectively collected data from January 2013 to December 2020 at the Medical University of Vienna. The inclusion criteria were singleton pregnancies with confirmed pre‐eclampsia and post‐diagnosis maternal serum angiogenic marker assessment in at least two time points. The primary outcome was the predictive performance of longitudinal sFlt‐1 and PlGF assessment for adverse maternal and perinatal outcomes compared to longitudinal conventional laboratory monitoring measured at the same time as the angiogenic markers in pregnancies with confirmed pre‐eclampsia. Composite maternal adverse outcomes included intensive care unit (ICU) admission, pulmonary edema, eclampsia, and death. Composite adverse perinatal outcomes included stillbirth, neonatal death, placental abruption, neonatal intensive care unit (NICU) admission, intraventricular hemorrhage, necrotizing enterocolitis, respiratory distress syndrome, and mechanical ventilator support.ResultsIn total 885 post‐diagnosis sFlt‐1/PlGF ratio measurements were taken from 323 pregnant women with confirmed pre‐eclampsia. For composite maternal adverse outcome, the highest stand‐alone predictive accuracy was obtained using maternal serum sFlt‐1/PlGF ratio (AUROC 0.72, 95% CI 0.62–0.81), creatinine (AUROC 0.71, 95% CI 0.62–0.81), and lactate dehydrogenase (LDH) levels (AUROC 0.73, 95% CI 0.65–0.81). Maternal platelet levels (AUROC 0.65, 95% CI 0.55–0.74), serum alanine transaminase (ALT) (AUROC 0.59, 95% CI 0.49–0.69) and aspartate aminotransferase (AST) (AUROC 0.61, 95% CI 0.51–0.71) levels had poor stand‐alone predictive accuracy. The best prediction model consisted of a combination of maternal serum LDH, creatinine levels and sFlt‐1/PlGF ratio, which had an AUROC of 0.77 (95% CI 0.68–0.85), significantly higher than sFlt‐1/PlGF ratio alone (P=0.037). For composite perinatal adverse outcome, the highest stand‐alone predictive accuracy was obtained using maternal serum sFlt‐1/PlGF ratio (AUROC 0.82, 95% CI 0.75–0.89) and creatinine (AUROC 0.74, 95% CI 0.67–0.80) levels, while sFlt‐1/PlGF ratio was superior to creatinine alone (P<0.001). Maternal serum LDH levels (AUROC 0.65, 95% CI 0.53–0.74), platelet count (AUROC 0.57, 95% CI 0.44–0.67), ALT (AUROC 0.58, 95% CI 0.48–0.67) and AST (AUROC 0.58, 95% CI 0.48–0.67) levels had poor stand‐alone predictive accuracy. No combination of biomarkers was superior to maternal serum sFlt‐1/PlGF ratio alone for composite perinatal adverse outcome (P>0.05 for all).ConclusionsLongitudinal maternal serum angiogenic marker assessment is a good predictor of adverse maternal and perinatal outcomes and superior to some of the conventional laboratory parameters in pregnancies with pre‐eclampsia. More studies should focus on the optimal surveillance following the diagnosis of pre‐eclampsia.This article is protected by copyright. All rights reserved.

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The additive role of angiogenic markers for women with confirmed preeclampsia

Cited by 13 publications

References 31 publications

Novel therapeutic and diagnostic approaches for preeclampsia

Novel therapeutic and diagnostic approaches for preeclampsia

Preeclampsia pathophysiology and adverse outcomes during pregnancy and postpartum

Longitudinal assessment of angiogenic markers in prediction of adverse outcome in women with confirmed pre‐eclampsia

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