Alpha Omega Alpha Honor Medical Society

2010 Research Abstract

Angiogenic biomarkers for the prediction of pregnancy complications in women with suspected preeclampsia

Investigator: Andreea Moore, The George Washington University School of Medicine
Co-investigators: Heather Young, Jennifer Keller, Linda Ojo, Jing Yan, Tiffany Moore Simas, Sharon Maynard
Mentor: Sharon Eileen Maynard, MD, The George Washington University School of Medicine

Objective: Alterations in soluble fms-like tyrosine kinase-1 (sFlt1), placental growth factor (PlGF), and soluble endoglin (sEng) have been implicated in the pathogenesis of preeclampsia. Our goal was to determine if maternal serum angiogenic factor levels are predictive of subsequent adverse maternal and neonatal outcomes in women with suspected preeclampsia.

Study Design: Maternal blood samples were prospectively collected from women presenting to hospital triage with suspected preeclampsia (hypertension, proteinuria, headache, vision changes, nausea/vomiting, or epigastric pain). sFlt1, PlGF, and sEng were measured by ELISA. The primary outcome was a composite of maternal and neonatal complications (elevated transaminases, thrombocytopenia, hemolysis, oliguria, renal injury, seizure, pulmonary edema, cerebral hemorrhage, delivery before 34 weeks, placental abruption, small for gestational age, neonatal intensive care admission, fetal/neonatal demise).

Results: 298 women with suspected preeclampsia were included in the analysis. 135 (56.7%) developed maternal or neonatal complications; of these, only 78 (57.7%) met diagnostic criteria for preeclampsia. sFlt1 and sEng were higher, and PlGF was lower, in women with complications as compared to those without complications (Table 1). Multivariable analysis showed all biomarkers were highly predictive of complications: odds ratio for complications in women in the highest vs. reference quartile was 4.5 for sFlt1 (95% CI 1.89-10.72), 8.26 for PlGF (95% CI 3.48-19.61), and 7.33 for sEng (95% CI 3.01-17.89). A multivariable model combining the sFlt1:PlGF ratio with clinical variables was highly predictive of complications (AUC 0.82, 95% CI 0.77-0.87).

Conclusion: Maternal serum sFlt1, sEng, and PlGF associate with maternal and neonatal complications in women presenting to hospital triage with suspected preeclampsia. Angiogenic biomarkers, in combination with clinical variables, may be useful for risk stratification in women with suspected preeclampsia.

Table 1. Median Biomarker Levles in Women Who Did and Did Not Develop the Primary Composite Outcome of Maternal and Neonatal Complications

Biomarker (pg/ml)Complications (n=135)No Complications (n=163)Wilcoxon p-value
SFlt12,799 (6589-22,088)8960 (5320-13,239)<0.0001
PlGF116 (57-225)173 (112-284<0.0001
sFlt:PlGF ratio129 (50-300)53 (20-98)<0.0001
sEng23.6 (11.2-46.5)12.2 (8-22)<0.0001

Results are given as median (interquartile range).

Updated on July 28, 2011.

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