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The sFlt-1/PlGF Ratio as Predictor of Adverse Maternal Outcome in Patients with Suspected Placental Insufficiency

Alfredo Perales-Marin, Francis Fernandez-de-la-Cruz, Marisa Martinez-Triguero, Amparo Alba-Redondo, Rogelio Monfort-Ortiz, Blanca Novillo-del-Alamo, Beatriz Marcos-Puig, Beatriz Marcos-Puig

Background: Angiogenic markers serve as crucial indicators of Adverse Pregnancy Outcomes (APRO). However, the variation in specific cut-off values used to assess APRO risk complicates their clinical utility. This study aims to identify the most predictive angiogenic marker or combination thereof for Adverse Maternal Outcomes (AMO), determining the optimal cut-off point for highest accuracy.

Methods: This observational retrospective cohort study utilized hospital medical records. We categorized singleton pregnancies (21-40 weeks gestation, n=60 each) into three groups based on sFlt-1/PlGF ratio levels: High (≥ 655), Intermediate (≥ 85 to <655) and Low (<85). Binary logistic regression was employed to identify the best predictors of AMO. Receiver Operating Characteristic (ROC) analysis was used to compare detection rates and determine the optimal cut-off.

Results: Significant differences were observed among the sFlt-1/PlGF groups (High>Intermediate>Low) for systolic and mean blood pressure, angiogenic markers, Aspartate Aminotransferase (AST), Alanine Transaminase (ALT) and AMO (p<0.001). The sFlt-1/PlGF ratio showed the highest Area Under the Curve (AUC) for predicting AMO compared to individual parameters. A cut-off point of 137 for the sFlt-1/PlGF ratio was identified, with no significant difference from the best models obtained. Assuming a pre-test AMO probability of 2%, the negative likelihood ratio was 0.098 and the positive likelihood ratio was 3.11. A negative test result yielded a post-test probability of AMO of 0.2%, while a positive test result yielded 7%.

Conclusion: The sFlt-1/PlGF ratio correlates with AMO severity and surpasses single parameters in predictive accuracy. A recommended cut-off of 137 for the sFlt-1/PlGF ratio is suggested for ruling out AMO in clinical practice.