44 Predictive value of repetitive measurement of sFlt-1:PLGF ratio in women with (suspected) preeclampsia

Introduction The ratio of the maternal plasma angiogenic factors soluble Fms-kinase 1 (sFlt-1) and placental growth factor (PlGF) is a novel diagnostic tool for preeclampsia (PE), with a value ⩽ 38 predicting short-term absence of PE in women in whom the syndrome is suspected clinically. The clinical implication of a single determination below the sFlt-1/PlGF ratio of 38 beyond 1 week remains to be established. Objective To assess the evolution of the sFlt-1/PlGF ratio in patients with (suspected) PE on clinical grounds. Methods In this ongoing observational study, the sFlt-1/PlGF ratio was determined (Elecsys assay, Roche Diagnostics) at ⩾ 2 time points in women with (suspected) PE based on the presence of ⩾ 1 of the following symptoms: new onset or aggravation of hypertension or proteinuria; renal insufficiency (serum creatinine > 100  μ mol/l); neurological complications (severe headache, hyperreflexia, persistent visual scotoma, blindness, stroke, seizures); severe edema or HELLP symptoms (right upper quadrant/epigastric abdominal pain; elevated transaminases; thrombocytopenia; hemolysis). Results We included 49 women (singleton pregnancies), aged 18-47 years and with a median pregnancy duration of 35 weeks (range 20-41 weeks). In those with a ratio ⩽ 38 (median 8 (range 2-37); n=30) at baseline, the ratio remained constant for up to 70 (range 26-107) days despite the fact that their protein-to-creatinine ratio and blood pressure often rose. In contrast, in those with a ratio > 38 (97 (range 42–991); n  = 19) at inclusion, the ratio rapidly increased further, often doubling every week. Conclusions A sFlt-1/PlGF ratio at inclusion ⩽ 38, does not result in a further rise, while a steep rise occurs in those with an inclusion ratio > 38.