Predictive ability of ratio of soluble FMS like tyrosine kinase-1 and Placental induced growth factor (sFLT-1/PIGF) in diagnosis of preeclampsia: A case control study.

Abstract

Background-Preeclampsia (PE) is a complicated disorder which is characterized by high blood pressure and proteinuria or the presence of end-organ dysfunctioning mostly occurring after 20 weeks of pregnancy. It is estimated that this condition affects between 2 to 5% of pregnancies globally. It is a systemic syndrome that originates from placenta and is associated with an imbalance between angiogenic factors in the maternal circulation. Now a days, anti-angiogenic factor, namely sFlt-1 (Soluble fms-like tyrosine kinase 1) and PlGF (Placental induced growth factor) which is a pro-angiogenic factor, have been proposed as promising biomarkers for predicting the occurrence of preeclampsia (PE) . Soluble fms-like tyrosine kinase 1 (sFlt-1) and PlGF are remarkably disturbed in preeclampsia. The ratio of maternal serum sFlt-1 to PlGF(sFlt-1/PIGF) has been used to rule out the occurrence of disease. The aim of this study is to highlight the predictive role of sFlt-1/PIGF ratio with regards to preeclampsia development in third trimester of pregnancy. Methods: A comparative study was made on 40 women with PE and 40 age-gestational-age matched women without PE, as case and control, respectively. Levels of sFlt-1, PIGF and the ratio of sflt-1/PIGF were compared between the two. Receiver Operating Characteristic (ROC) curve analysis was done to calculate diagnostic accuracy of sFlt-1/PIGF ratio. Results- - Serum level of sFlt-1 was significantly higher in preeclamptic patients (3487.58±1543.46pg/ml) than in controls (2824.67±1050.24pg/ml) whereas PIGF was significantly lower in preeclamptic patients (78.54±152.63pg/ml) than controls (553.73±263.27pg/ml). The mean sflt-1/PIGF ratio in cases was 78.54±40.37pg/ml which is higher than mean sFlt-1/PIGF of controls which was 37.14±149.70. When ROC analysis was done sFlt-1/PIGF>22.53 was found giving highest Youden index with sensitivity of 100% and specificity of 94.87 and AUC=0.94 . Conclusion-This study looked at the evaluation of sFlt-1 levels, serum PIGF levels and their ratio sFlt-1/PIGF and judging diagnostic accuracy of sFlt-1/PIGF in preeclamptic females in the third trimester of pregnancy. The level of sFlt-1 was higher in preeclamptic female whereas PIGF level was low and ratio sFlt-1/PIGF was also on the higher side. Hence the combined measurement and calculation of their ratio may help in making better diagnosis and more specific disease management.