The Role of Soluble Fms-like Tyrosine Kinase 1 and Maternal Characteristics in Preeclampsia Scoring Card as a Predictor of Severe Preeclampsia

Abstract

Preeclampsia is the leading cause of maternal mortality and morbidity worldwide. The capacity to predict maternal and neonatal outcome in pregnant women with preeclampsia remain immature although advanced have been made in obstetrics. Recent studies reported an antiangiogenic substance called Soluble Fms-like Tyrosin Kinase-1 (sFlt-1) produced by the placenta of preeclampsia patients. It binds to Vascular Endothelial Growth Factor (VEGF) and Placental Growth Factor (PIGF) and act as a proangiogenic substance. The earliest period whereby sFlt-1 can be detected around 5 weeks prior to symptoms onset. This value increases dramatically as soon as symptoms arise. Whether sFlt-1 causes placentation problem or sFlt-1 is the result of placenta implantation defect is still unknown. This present study aimed at establishing a prognostic tool through sFlt-1 and maternal characteristics therefore reducing the rate of mortality in pregnant women with preeclampsia and aiding clinical assessments and interventions. In a nested case control study, 40 preeclampsia women diagnosed clinically were enrolled. By determining angiogenic factors and maternal characteristics were determined that could be used as a prognostic tool through logistic regression. In this study, the scoring card had good calibration and discrimination value with a p-value >0,05 and AUC 0.917 (95% CI 0.833 to 1.00). Respectively, subjects with total scores of 0, 1, 2, and 3 had 0.23%, 4.6%, 50.4%, and 95% chance of poor prognosis. Maternal age, gestational age, and levels of sFlt-1 appear to be strong predictors for poor clinical outcomes in patients with preeclampsia.

Keywords: Severe preeclampsia, clinical predictor, poor prognosis