Angiogenic Factors and the Risk of Adverse Outcomes in Women With Suspected Preeclampsia

DOI Web Site 被引用文献10件
  • Sarosh Rana
    From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R., S.S., K.-H.L., S.A.K.), and Department of Medicine (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (C.E.P., J.B.W., R.T.); Department of Obstetrics, Campus Virchow-Clinic (S.V.), and Department of Laboratory Medicine, Clinical Chemistry, and...
  • Camille E. Powe
    From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R., S.S., K.-H.L., S.A.K.), and Department of Medicine (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (C.E.P., J.B.W., R.T.); Department of Obstetrics, Campus Virchow-Clinic (S.V.), and Department of Laboratory Medicine, Clinical Chemistry, and...
  • Saira Salahuddin
    From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R., S.S., K.-H.L., S.A.K.), and Department of Medicine (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (C.E.P., J.B.W., R.T.); Department of Obstetrics, Campus Virchow-Clinic (S.V.), and Department of Laboratory Medicine, Clinical Chemistry, and...
  • Stefan Verlohren
    From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R., S.S., K.-H.L., S.A.K.), and Department of Medicine (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (C.E.P., J.B.W., R.T.); Department of Obstetrics, Campus Virchow-Clinic (S.V.), and Department of Laboratory Medicine, Clinical Chemistry, and...
  • Frank H. Perschel
    From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R., S.S., K.-H.L., S.A.K.), and Department of Medicine (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (C.E.P., J.B.W., R.T.); Department of Obstetrics, Campus Virchow-Clinic (S.V.), and Department of Laboratory Medicine, Clinical Chemistry, and...
  • Richard J. Levine
    From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R., S.S., K.-H.L., S.A.K.), and Department of Medicine (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (C.E.P., J.B.W., R.T.); Department of Obstetrics, Campus Virchow-Clinic (S.V.), and Department of Laboratory Medicine, Clinical Chemistry, and...
  • Kee-Hak Lim
    From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R., S.S., K.-H.L., S.A.K.), and Department of Medicine (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (C.E.P., J.B.W., R.T.); Department of Obstetrics, Campus Virchow-Clinic (S.V.), and Department of Laboratory Medicine, Clinical Chemistry, and...
  • Julia B. Wenger
    From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R., S.S., K.-H.L., S.A.K.), and Department of Medicine (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (C.E.P., J.B.W., R.T.); Department of Obstetrics, Campus Virchow-Clinic (S.V.), and Department of Laboratory Medicine, Clinical Chemistry, and...
  • Ravi Thadhani
    From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R., S.S., K.-H.L., S.A.K.), and Department of Medicine (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (C.E.P., J.B.W., R.T.); Department of Obstetrics, Campus Virchow-Clinic (S.V.), and Department of Laboratory Medicine, Clinical Chemistry, and...
  • S. Ananth Karumanchi
    From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R., S.S., K.-H.L., S.A.K.), and Department of Medicine (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (C.E.P., J.B.W., R.T.); Department of Obstetrics, Campus Virchow-Clinic (S.V.), and Department of Laboratory Medicine, Clinical Chemistry, and...

抄録

<jats:sec> <jats:title>Background—</jats:title> <jats:p>An imbalance in circulating angiogenic factors plays a central role in the pathogenesis of preeclampsia.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p> We prospectively studied 616 women who were evaluated for suspected preeclampsia. We measured plasma levels of antiangiogenic soluble fms-like tyrosine kinase 1 (sFlt1) and proangiogenic placental growth factor (PlGF) at presentation and examined for an association between the sFlt1/PlGF ratio and subsequent adverse maternal and perinatal outcomes within 2 weeks. The median sFlt1/PlGF ratio at presentation was elevated in participants who experienced any adverse outcome compared with those who did not (47.0 [25th–75th percentile, 15.5–112.2] versus 10.8 [25th–75th percentile, 4.1–28.6]; <jats:italic>P</jats:italic> <0.0001). Among those presenting at <34 weeks (n=167), the results were more striking (226.6 [25th–75th percentile, 50.4–547.3] versus 4.5 [25th–75th percentile, 2.0–13.5]; <jats:italic>P</jats:italic> <0.0001), and the risk was markedly elevated when the highest sFlt1/PlGF ratio tertile was compared with the lowest (odds ratio, 47.8; 95% confidence interval, 14.6–156.6). Among participants presenting at <34 weeks, the addition of sFlt1/PlGF ratio to hypertension and proteinuria significantly improved the prediction for subsequent adverse outcomes (area under the curve, 0.93 for hypertension, proteinuria, and sFlt1/PlGF versus 0.84 for hypertension and proteinuria alone; <jats:italic>P</jats:italic> =0.001). Delivery occurred within 2 weeks of presentation in 86.0% of women with an sFlt1/PlGF ratio ≥85 compared with 15.8% of women with an sFlt1/PlGF ratio <85 (hazard ratio, 15.2; 95% confidence interval, 8.0–28.7). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>In women with suspected preeclampsia presenting at <34 weeks, circulating sFlt1/PlGF ratio predicts adverse outcomes occurring within 2 weeks. The accuracy of this test is substantially better than that of current approaches and may be useful in risk stratification and management. Additional studies are warranted to validate these findings.</jats:p> </jats:sec>

収録刊行物

  • Circulation

    Circulation 125 (7), 911-919, 2012-02-21

    Ovid Technologies (Wolters Kluwer Health)

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