A new angiogenic classification with PlGF and sFlt-1 for hypertensive disorders of pregnancy

Objective. The ratio between two angiogenic markers, sFlt- 1 (Soluble fms-Like Tyrosine Kinase-1) and PlGF (Placental Growth Factor), plays a crucial role in managing hypertensive disorders of pregnancy (HDP), notably preeclampsia (preE), aiding in diagnosis and outcome prediction. This study aimed to demonstrate the non-equivalence of sFlt-1/PlGF ratios within current risk categories and suggest a new classification.
Materials and Methods. A retrospective study analysed sin­gleton pregnancies hospitalized for HDP after the 20th gesta­tional week from May 2018 to December 2020. Patients were classified based on the sFlt-1/PlGF ratio (low < 38, medium 38-85/110*, high > 85 or > 110*, and very high > 655 or > 201* ‒ *after the 34th week) and into nine categories respect­ing PlGF and sFlt-1 levels for gestational age (GA) (within range, above or below).
Results. The cohort comprised 182 patients, with a mean GA at testing of 35+1 weeks (21-41+1) and at delivery of 36+6 weeks (23+3-41+3). Notable categories included Category 6 (PlGF below range-sFlt-1 above range,38%) and Category 1 (both PlGF and sFlt-1 within reference range, 30%). Category 6 patients had the highest risk of adverse outcomes, including premature birth (75%), urgent caesarean section for HDP com­plications (48%), the necessity of antihypertensive therapy be­fore and after delivery (64 and 67%), a higher percentage of growth-restricted foetuses (59%), and severe clinical presen­tations (36%).
Conclusions. A new classification system for PlGF and sFlt- 1, which considers alterations of each marker relative to GA at testing, improves the management of HDP compared to current stratification. This approach helps to avoid underesti­mating high-risk cases with a low/medium ratio and enables better stratification of the high-risk category.

Table of Content: Vol. 36 (Supplement No. 1) 2024 – Conference Proceedings

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