Back to Search
Start Over
Maternal plasma concentrations of angiogenic/anti-angiogenic factors are of prognostic value in patients presenting to the obstetrical triage area with the suspicion of preeclampsia
- Source :
- The Journal of Maternal-Fetal & Neonatal Medicine. 24:1187-1207
- Publication Year :
- 2011
- Publisher :
- Informa UK Limited, 2011.
-
Abstract
- To determine whether maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng), soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and -2 could identify patients at risk for developing preeclampsia (PE) requiring preterm delivery.Patients presenting with the diagnosis "rule out PE" to the obstetrical triage area of our hospital at37 weeks of gestation (n = 87) were included in this study. Delivery outcomes were used to classify patients into four groups: I) patients without PE or those with gestational hypertension (GHTN) or chronic hypertension (CHTN) who subsequently developed PE at term (n = 19); II): mild PE who delivered at term (n = 15); III): mild disease (mild PE, GHTN, CHTN) who subsequently developed severe PE requiring preterm delivery (n = 26); and IV): diagnosis of severe PE (n = 27). Plasma concentrations of PlGF, sEng, sVEGFR-1 and -2 were determined at the time of presentation by ELISA. Reference ranges for analytes were constructed by quantile regression in our laboratory (n = 180; 1046 samples). Comparisons among groups were performed using multiples of the median (MoM) and parametric statistics after log transformation. Receiver operating characteristic curves, logistic regression and survival analysis were employed for analysis.The mean MoM plasma concentration of PlGF/sVEGFR-1, PlGF/sEng, PlGF, sVEGFR-1 and -2, and sEng in Group III was significantly different from Group II (all p0.05). A plasma concentration of PlGF/sVEGFR-1 ≤ 0.05 MoM or PlGF/sEng ≤0.07 MoM had the highest likelihood ratio of a positive test (8.3, 95% CI 2.8-25 and 8.6, 95% CI 2.9-25, respectively), while that of PlGF ≤0.396 MoM had the lowest likelihood ratio of a negative test (0.08, 95% CI 0.03-0.25). The association between low plasma concentrations of PlGF/sVEGFR-1 (≤0.05 MoM) as well as that of PlGF/sEng (≤0.07 MoM) and the development of severe PE remained significant after adjusting for gestational age at presentation, average systolic and diastolic blood pressure, and a history of chronic hypertension [adjusted odds ratio (OR) = 27 (95% CI 6.4-109) and adjusted OR 30 (95% CI 6.9-126), respectively]. Among patients who presented34 weeks gestation (n = 59), a plasma concentration of PlGF/sVEGFR-10.033 MoM identified patients who delivered within 2 weeks because of PE with a sensitivity of 93% (25/27) and a specificity of 78% (25/32). This cut-off was associated with a shorter interval-to-delivery due to PE [hazard ratio = 6 (95% CI 2.5-14.6)].Plasma concentrations of angiogenic/anti-angiogenic factors are of prognostic value in the obstetrical triage area. These observations support the value of these biomarkers in the clinical setting for the identification of the patient at risk for disease progression requiring preterm delivery.
- Subjects :
- Adult
Placental growth factor
Gestational hypertension
medicine.medical_specialty
Receptors, Cell Surface
Pregnancy Proteins
Article
Preeclampsia
Young Adult
Pre-Eclampsia
Antigens, CD
Pregnancy
medicine
Humans
Young adult
Obstetrics and Gynecology Department, Hospital
Placenta Growth Factor
Retrospective Studies
Vascular Endothelial Growth Factor Receptor-1
business.industry
Obstetrics
Endoglin
Obstetrics and Gynecology
Retrospective cohort study
Prognosis
medicine.disease
Vascular Endothelial Growth Factor Receptor-2
Pediatrics, Perinatology and Child Health
Gestation
Female
Triage
business
Biomarkers
Subjects
Details
- ISSN :
- 14764954 and 14767058
- Volume :
- 24
- Database :
- OpenAIRE
- Journal :
- The Journal of Maternal-Fetal & Neonatal Medicine
- Accession number :
- edsair.doi.dedup.....a4f8badf35693d19a814ce7fc5db4ac3