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Significance of the sFlt-1/PlGF Ratio in Certain Cohorts - What Needs to be Considered?
Oliver Graupner1, Stefan Verlohren2, Tanja Groten3
1Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum rechts der Isar, Technische Universität München, München, Germany.
Insights
The soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio aids preeclampsia diagnosis and prognosis. However, comorbidities like obesity or twin pregnancy can alter its accuracy, necessitating further research into adjusted cut-off values.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Chemistry
Background:
- The soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio is a clinically validated biomarker for preeclampsia (PE).
- Its diagnostic and prognostic performance can be influenced by maternal and gestational comorbidities.
- Understanding these influences is crucial for accurate clinical application.
Purpose of the Study:
- To conduct a narrative review of current literature.
- To evaluate the diagnostic and predictive performance of the sFlt-1/PlGF ratio in specific patient cohorts.
- To identify factors affecting the ratio's clinical utility.
Main Methods:
- Literature search and synthesis.
- Narrative review of studies on sFlt-1/PlGF ratio performance.
- Analysis of factors impacting ratio interpretation.
Main Results:
- Chronic kidney disease, twin pregnancy, and maternal obesity are identified as factors potentially impairing the sFlt-1/PlGF ratio's performance.
- Pathophysiological changes associated with these conditions can alter sFlt-1 and PlGF concentrations.
- Standard cut-off values may lead to misinterpretation in these specific cohorts.
Conclusions:
- The clinical interpretability and applicability of the sFlt-1/PlGF ratio are challenged by certain comorbidities.
- Adaptation of standard cut-off values for specific patient groups requires further investigation.
- Large prospective cohort studies are needed to clarify optimal usage for diagnosis and prognosis in diverse populations.
Abstract:
The sFlt-1/PlGF ratio is an established tool in clinical practice, where it is part of a diagnostic algorithm and informs the prognosis of preeclampsia (PE). Maternal and gestational comorbidities can affect the performance of the sFlt-1/PlGF ratio and its constituent elements, and a good understanding of the potential pitfalls is required. The objective of this paper was to provide a current narrative review of the literature on the diagnostic and predictive performance of the sFlt-1/PlGF ratio in specific patient cohorts. Potential factors which can negatively affect the clinical interpretability and applicability of the sFlt-1/PlGF ratio include chronic kidney disease, twin pregnancy, and maternal obesity. Pathophysiological mechanisms related to these factors and disorders can result in different concentrations of sFlt-1 and/or PlGF in maternal blood, meaning that the use of standard cut-off values in specific cohorts can lead to errors. To what extent the cut-off values should be adapted in certain patient cohorts can only be clarified in large prospective cohort studies. This applies to the use of the ratio both for diagnosis and prognosis.
