The use of angiogenic factors in discriminating preeclampsia: are they ready for prime time?

Abstract

Objectives. We sought to evaluate the association between soluble fms-like tyrosine kinase 1 (sFlt1) and endoglin (ENG) and preeclampsia in an urban population, to develop a discriminatory model, and evaluate the association of these biomarkers with small for gestational age (SGA).

Methods. Cases are prospectively identified with preeclampsia. Controls are term patients without preeclampsia. Commercially available ELISAs were used to measure levels of sFlt1, ENG, and placental growth factor (PlGF). Log-transformed levels were compared and multivariable logistic regression analyses were performed to control for confounders. Receiver operating characteristic curves were developed.

Results. In cases (n = 86) compared to controls (n = 288), sFlt1 (p = 0.24) levels were no different. However, ENG levels were higher (p < 0.001), and PlGF levels were lower (p < 0.001). Further, levels of sFlt1 had poor discriminatory ability between cases and controls [AUC = 0.56, (0.48–0.63)]. The best model to discriminate between groups included clinical risk factors, ENG, and PlGF [AUC = 0.89, (0.85–0.92)].

Conclusions. Unlike recent reports, this study suggests that sFlt1 may have limited diagnostic utility in predicting preeclampsia, especially term disease.

Keywords:

• Preeclampsia
• angiogenic factors
• intra-uterine growth restriction
• hypertension

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.