Ann Lab Med 2018; 38(2): 95-101  https://doi.org/10.3343/alm.2018.38.2.95
Evaluation of sFlt-1/PlGF Ratio for Predicting and Improving Clinical Management of Pre-eclampsia: Experience in a Specialized Perinatal Care Center
Hélène Caillon, Ph.D.1, Cécile Tardif, M.D.2, Erwan Dumontet, M.D.1, Norbert Winer, Ph.D.2, and Damien Masson, Ph.D.1
Department of Biochemistry1, Nantes University Hospital, France; Department of Gynecology and Obstetrics2, Nantes University Hospital, Nantes, France
Corresponding author: Hélène Caillon
Laboratoire de Biochimie, CHU Nantes, 9 quai Moncousu, 44093 Nantes, France
Tel: +33-2-40083989
Fax: +33-2-40083991
E-mail: helene.caillon@chu-nantes.fr
Received: May 23, 2017; Revised: July 4, 2017; Accepted: October 23, 2017; Published online: March 1, 2018.
© Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Management of pregnant women at high risk of pre-eclampsia (PE) requires frequent monitoring, with referral to specialized perinatal care centers. Reliable tests are necessary to improve prediction of PE and related complications and to assess disease severity and progression. An imbalance in two biomarkers, soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF), is involved in PE pathogenesis. The sFlt-1 to PlGF ratio is increased in pregnant women before the onset of PE. An elevated ratio is highly predictive of PE, whereas the diagnosis of PE can be ruled out within one week for low ratios. The main objective of this study was to assess whether a low sFlt-1/PlGF ratio, below a cutoff of 38, can predict the absence of PE within one week.
Methods: We performed a prospective, monocentric, observational study to evaluate serum sFlt-1/PlGF ratio (Roche Diagnostics Cobas e411 system) for predicting -PE in a group of 67 high-risk pregnant women (20–37 gestation weeks).
Results: Among the 67 patients included, 53 had a sFlt-1/PlGF ratio lower than 38; none developed subsequent PE leading to a negative predictive value of 100%. Eight patients developed clinical PE. The positive predictive value was 21% at one week and 18% at four weeks, in accordance with previous studies.
Conclusions: The serum sFlt-1/PlGF ratio showed highly predictive performances for ruling out PE. Using these biomarkers in routine management of PE may improve clinical care and avoid inappropriate hospitalization, which has a significant economic impact.
Keywords: Pre-eclampsia, Soluble fms-like tyrosine kinase 1/placental growth factor ratio, Performance



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