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

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.