Automated measurement of sFlt1, PlGF and sFlt1/PlGF ratio in differential diagnosis of hypertensive pregnancy disorders.

Objectives: The utility of angiogenic and antiangiogenic biomarkers as diagnostic tools in preeclampsia (PE) has been shown in previous studies. Our study's aim was to evaluate the use of automated measurement of sFlt1, PlGF and their ratio (sFlt1/PlGF) in differential diagnosis of hypertensive pregnancy disorders.

Patients/methods: Sixty-four patients with PE/HELLP, 18 with pregnancy-induced hypertension (PIH), 22 with gestational proteinuria (GP) and 232 controls were investigated. The PE/HELLP group was divided into mild PE (mPE, n=31), severe PE (sevPE, n=20), superimposed PE (supPE, n=7) and HELLP syndrome (n=6). sFlt1 and PlGF were measured in serum samples on an automated platform. Statistical analysis was performed using parametric and non-parametric methods, ROC analysis and logistic regression method.

Results: PE patients showed higher sFlt1 and ratio and lower PlGF than controls (median ± SEM in pg/mL; 10888 ± 878 versus 2456 ± 116; 268 ± 39 versus 16 ± 2 and 68 ± 6 versus 439 ± 37, each p<0.001), subgroups showed similar differences in ratios (median ± SEM; supPE: 202 ± 110; mPE: 137 ± 27; sevPE: 497 ± 91; HELLP syndrome: 254 ± 72 versus controls 16 ± 2, each p<0.001). ROC analysis showed best performance for sFlt1/PlGF (AUC all PE: ratio 96.4%, sFlt1 92.8%, PlGF 92.4%, supPE: ratio 93.6%, mPE: ratio 94.8%, sevPE: ratio 99.4%, HELLP: ratio 98.6%, each versus controls). Patients with PIH and GP showed significant differences compared to controls (p ≤ 0.01, respectively), mPE (p ≤ 0.007), sevPE (p<0.001) and HELLP syndrome (p ≤ 0.003).

Conclusion: The automated measurement of sFlt1/PlGF is a reliable diagnostic tool in differential diagnosis of hypertensive pregnancy disorders and gives additional valuable information for clinical management.