Role of Soluble Fms-like Tyrosine Kinase 1 / Placental Growth Factor Ratio In Prediction of Preeclampsia

Abstract

Preeclampsia (PE) is an important cause of fetal and maternal morbidity and mortality worldwide. It complicates about 5% of pregnancies (Hutcheon et al., 2011). There is growing evidence supporting the role of angiogenic proteins in the diagnosis and prediction of PE. The markers most frequently studied are the proangiogenic protein, placental growth factor (PlGF), and the antiangiogenic protein, soluble vascular endothelial growth factor receptor 1 (sVEGFR1), also referred to as soluble fms-like tyrosine kinase 1 or (sFlt-1) (Sunderji et al, 2010). An increase in sFlt-1 and a decrease in PlGF have been revealed in maternal serum five to ten weeks before the onset of preeclampsia (R. J. Levine et al, 2004). It has been postulated that these changes in sFlt-1 and PlGF may contribute to the pathogenesis of preeclampsia (R. J. Levine et al, 2004; R. J. Levine et al, 2006).Thus, these two particular factors have been proposed as candidates for an efficient screening in the prediction of preeclampsia (R. J. Levine et al, 2006; T. Chaiworapongsa et al, 2005;R. Romero et al, 2008). This study aims to measure the accuracy of the sFlt-1 / PIGF ratio to predict the occurrence of PE. This is a nested case control study conducted at Ain-Shams University Maternity hospital from June 2015 to December 2015 Patients included in this study were 50 pregnant women came for routine antenatal care visits. The participant were divided into two groups, Women who developed subsequently preeclampsia (𝑛 = 25) made up the case group (group A). While the control group(group B) consisted of randomly selected women with normal pregnancy outcome (𝑛 = 25).

Summary

In this study, we supported the suggestion that preeclampsia is associated with the disturbed relationship between angiogenic and antiangiogenic factors. We have evaluated sFlt-1 and PlGF concentrations in a late second and early third trimester pregnant women, and it was established that serum sFlt-1 and PlGF levels in women who subsequently developed preeclampsia behaved differently when compared with women who had a normal pregnancy outcome. Levels of sFlt-1 (antiangiogenic factor) elevated and the levels of PlGF (angiogenic factor) declined. Furthermore, when we evaluated the sFlt-1/PlGF ratio for the prediction of preeclampsia, we found that it was significantly higher in women who consequently developed preeclampsia than the control group. At blood sampling, age, gestational age, body mass index, systolic blood pressure, diastolic blood pressure and urine protein were not significantly different between the two study groups. At delivery systolic blood pressure, diastolic blood pressure, and albuminuria were significantly higher for participants in the case group than for those in the control group (p < 0.001). Also platelet count, serum creatinine, ALT, and INR were significantly higher for participants in the case group than those in the control group (p < 0.oo1, p <0.o42, p <0.o42, and p <0.o48) respectively. While hemoglobin and AST were not significantly different between the two study groups. Median serum level of sFlt-1 was significantly higher in the case group compared to women in the control group. In contrast, median serum level of PlGF wasn’t significantly lower in women of the case group compared to those in the control group. In women with preeclampsia, the median sFlt-1/PlGF ratio was significantly higher compared to the control group.