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Provendier A, Migliorelli F, Loussert L, Boileau BG, Vayssiere C, Hamdi SM, Hanaire H, Dupuis N, Guerby P. The sFLT-1/PlGF Ratio for the Prediction of Preeclampsia-Related Adverse Fetal and Maternal Outcomes in Women with Preexisting Diabetes. Reprod Sci 2024; 31:2371-2378. [PMID: 38605263 DOI: 10.1007/s43032-024-01540-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
To evaluate the predictive value of the sFlt-1/PlGF ratio for the prediction of preeclampsia in women with preexisting diabetes mellitus. This is a monocentric retrospective observational study conducted between January 2018 and December 2020. All singleton pregnancies with preexisting diabetes mellitus, who had a dosage of the sFlt-1/PlGF ratio between 30 and 34 + 6 weeks of gestation were included. The principal outcome was preeclampsia. The secondary outcomes were preterm preeclampsia, gestational hypertension, placental abruption, intrauterine fetal death, IUGR, small for gestational age and a composite outcome named "hypertensive disorder of pregnancy" including gestational hypertension, preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count). Of 63 patients, 22% presented preeclampsia. The area under the curve of sFlt-1/PlGF ratio was 0.90 (95% CI: 0.79-0.96) for the prediction of preeclampsia. The receiver operator characteristic analysis suggested that the optimal sFlt-1/PlGF cutoff to predict preeclampsia was 29, with a sensitivity of 86% (95% CI: 60.1-96.0) and a specificity of 92% (95% CI: 80.8-96.8). A cut-off of 38 provided a sensitivity of 71% (95% CI: 45.4-88.3), a specificity of 92% (95% CI: 80.8-96.8). Further analysis using multivariable methods revealed nephropathy was significantly associated with PE (p = 0.014). The use of the sFlt-1/PlGF ratio during the third trimester of pregnancy seems to be of interest as a prognostic tool to improve multidisciplinary management of patients with preexisting diabetes mellitus.
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Affiliation(s)
- Anais Provendier
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Federico Migliorelli
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Lola Loussert
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Béatrice Guyard Boileau
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Safouane M Hamdi
- Department of Biochemistry and Hormonology, University Paul Sabatier, Toulouse, France
| | - Hélène Hanaire
- Department of Endocrinology and Diabetology, University Paul Sabatier, Toulouse, France
| | - Ninon Dupuis
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France.
- Toulouse Institute for Infectious and Inflammatory Diseases, Inserm UMR 1291 - CNRS UMR 5051- University Toulouse III, Toulouse, France.
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Shinohara S, Hiraoka N, Mochizuki K, Yasuda G, Kasai M, Sunami R. sFlt-1/PlGF ratio predicts serious outcomes in confirmed early-onset preeclampsia. Eur J Obstet Gynecol Reprod Biol 2024; 300:159-163. [PMID: 39003888 DOI: 10.1016/j.ejogrb.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/18/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES We aimed to determine whether a high ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) would be associated with serious negative consequences and shorter pregnancy duration in cases of early-onset preeclampsia (PE). STUDY DESIGN This retrospective cohort study included women (n = 65) diagnosed with PE at <34.0 weeks of gestation and recruited from a single primary and tertiary medical centre in Japan. The sFlt-1/PlGF ratio in the study participants was measured. To determine the optimal threshold for the sFlt-1/PlGF ratio, a receiver operating characteristic curve was employed, with the aim of predicting serious adverse outcomes within 1 week after serum angiogenic marker measurements. We performed Kaplan-Meier analysis and the log-rank test to assess delivery probability based on the sFlt-1/PlGF ratio. RESULTS Thirty-seven women (56.9 %) delivered within 1 week of serum angiogenic marker measurements due to the aggravation of early-onset preeclampsia. Women who developed serious adverse outcomes within 1 week had a significantly higher sFlt-1/PlGF ratio than that of women who did not develop serious complications (408.5 vs. 166.6, P < 0.001). A cut-off value of 224.6 for the sFlt-1/PlGF ratio predicted serious adverse outcomes, with a sensitivity of 81.1 % and a specificity of 71.4 % (area under the curve: 0.77). Moreover, 78.9 % of women with an sFlt-1/PlGF ratio ≥ 224.6 compared to 25.9 % of those with an sFlt-1/PlGF ratio < 224.6 delivered within 1 week of presentation (P < 0.001). CONCLUSIONS Women with confirmed early-onset preeclampsia and high sFlt-1/PlGF ratio are more likely to develop serious adverse outcomes within 1 week after serum angiogenic marker measurements.
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Affiliation(s)
- Satoshi Shinohara
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi 400-8506, Japan
| | - Nozomi Hiraoka
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi 400-8506, Japan
| | - Kana Mochizuki
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi 400-8506, Japan
| | - Genki Yasuda
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi 400-8506, Japan
| | - Mayuko Kasai
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi 400-8506, Japan
| | - Rei Sunami
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi 400-8506, Japan.
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Loussert L, Dupuis N, Guerby P. Optimal antenatal corticosteroids timing in women with nonsevere preeclampsia. Am J Obstet Gynecol 2024; 230:e123. [PMID: 38382827 DOI: 10.1016/j.ajog.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/15/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Lola Loussert
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU de Toulouse, Toulouse, France
| | - Ninon Dupuis
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU de Toulouse, Toulouse, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU de Toulouse, Toulouse, France; INFINITY CNRS, Inserm UMR 129, Université Toulouse III, Toulouse, France.
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Januzzi JL, Liu Y, Sattar N, Yavin Y, Pollock CA, Butler J, Jardine M, Heerspink HJL, Masson S, Breyer M, Hansen MK. Vascular endothelial growth factors and risk of cardio-renal events: Results from the CREDENCE trial. Am Heart J 2024; 271:38-47. [PMID: 38401646 DOI: 10.1016/j.ahj.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/30/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Circulating concentrations of vascular endothelial growth factor (VEGF) family members may be abnormally elevated in type 2 diabetes (T2D). The roles of placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFLT-1), and VEGF-A in cardio-renal complications of T2D are not established. METHOD The 2602 individuals with diabetic kidney disease (DKD) from the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation trial were randomized to receive canagliflozin or placebo and followed for incident cardio-renal outcomes. PlGF, sFLT-1, and VEGF-A were measured at baseline, year 1, and year 3. Primary outcome was a composite of end-stage kidney disease, doubling of the serum creatinine, or renal/cardiovascular death. Cox proportional hazard regression was used to investigate the association between biomarkers with adverse clinical events. RESULTS At baseline, individuals with higher PlGF levels had more prevalent cardiovascular disease compared to those with lower values. Treatment with canagliflozin did not meaningfully change PlGF, sFLT-1, and VEGF-A concentrations at years 1 and 3. In a multivariable model, 1 unit increases in baseline log PlGF (hazard ratio [HR]: 1.76, 95% confidence interval [CI]: 1.23, 2.54, P-value = .002), sFLT-1 (HR: 3.34, [95% CI: 1.71, 6.52], P-value < .001), and PlGF/sFLT-1 ratio (HR: 4.83, [95% CI: 0.86, 27.01], P-value = .07) were associated with primary composite outcome, while 1 unit increase in log VEGF-A did not increase the risk of primary outcome (HR: 0.96 [95% CI: 0.81, 1.07]). Change by 1 year of each biomarker was also assessed: HR (95% CI) of primary composite outcome was 2.45 (1.70, 3.54) for 1 unit increase in 1-year concentration of log PlGF, 4.19 (2.18, 8.03) for 1 unit increase in 1-year concentration of log sFLT-1, and 21.08 (3.79, 117.4) for 1 unit increase in 1-year concentration of log PlGF/sFLT-1. Increase in 1-year concentrations of log VEGF-A was not associated with primary composite outcome (HR: 1.08, [95% CI: 0.93, 1.24], P-value = .30). CONCLUSIONS People with T2D and DKD with elevated levels of PlGF, sFLT-1, and PlGF/sFLT-1 ratio were at a higher risk for cardiorenal events. Canagliflozin did not meaningfully decrease concentrations of PlGF, sFLT-1, and VEGF-A. CLINICAL TRIAL CREDENCE, https://clinicaltrials.gov/ct2/show/NCT02065791.
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Affiliation(s)
- James L Januzzi
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Heart Failure and Biomarker Trials, Baim Institute for Clinical Research, Boston, MA.
| | - Yuxi Liu
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Yshai Yavin
- Janssen Research & Development, LLC, Spring House, PA
| | - Carol A Pollock
- Kolling Institute, Royal North Shore Hospital University of Sydney, Sydney, NSW, Australia
| | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS; Baylor Scott & White Institute, Dallas, TX
| | - Meg Jardine
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Hiddo J L Heerspink
- Department Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Serge Masson
- Roche Diagnostics International, Rotkreuz, Switzerland
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Sun G, Xu Q, Zhang S, Yang L, Liu G, Meng Y, Chen A, Yang Y, Li X, Hao D, Liu X, Shao J. Predicting hypertensive disorders in pregnancy using multiple methods: Models with the placental growth factor parameter. Technol Health Care 2021; 29:427-432. [PMID: 33682779 PMCID: PMC8150465 DOI: 10.3233/thc-218040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Placental growth factor (PlGF), one of the biomarkers, has a certain predictive effect on hypertensive disorders in pregnancy (HDP). OBJECTIVE To study the HDP prediction effect of different methods for variable selection and modeling for models containing PlGF. METHODS For the model containing PlGF, the appropriate range of PlGF parameters needed to be selected. Step-logistic regression and lasso were used to compare the model effect of twice range selection. The PlGF model with good predictive effect and appropriate detecting gestational age was selected for the final prediction. RESULTS The effect of the model containing PlGF tested at 15-16 weeks was better than the PlGF value without comprehensive screening. The sensitivity of both methods was over 92%. By comprehensive comparison, the final model of lasso method in this study was more effective. CONCLUSIONS In this study, a variety of methods were used to screen models containing PlGF parameters. According to clinical needs and model effects, the optimal HDP prediction model with PlGF parameters in the second trimester of 15-26 weeks of pregnancy was finally selected.
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Affiliation(s)
- Ge Sun
- Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing 100124, China.,Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
| | - Qi Xu
- Peking University People's Hospital, Beijing 100044, China
| | - Song Zhang
- Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing 100124, China.,Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
| | - Lin Yang
- Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing 100124, China.,Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
| | - Guoli Liu
- Peking University People's Hospital, Beijing 100044, China
| | - Yu Meng
- Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing 100124, China.,Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
| | - Aiqing Chen
- Beijing Yes Medical Devices Co. Ltd., Beijing 100152, China
| | - Yimin Yang
- Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing 100124, China.,Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
| | - Xuwen Li
- Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing 100124, China.,Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
| | - Dongmei Hao
- Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing 100124, China.,Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing 100124, China
| | - Xiaohong Liu
- Beijing Yes Medical Devices Co. Ltd., Beijing 100152, China
| | - Jing Shao
- Beijing Yes Medical Devices Co. Ltd., Beijing 100152, China
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