Diagnostic and prognostic role of thrombospondin-4 levels in pre-eclampsia: Association with onset type, severity, and perinatal outcome.

To evaluate the diagnostic and prognostic significance of maternal serum thrombospondin-4 (TSP-4) levels in pre-eclampsia (PE), including comparisons between early- and late-onset disease and between mild and severe cases, and to examine associations with adverse perinatal outcomes. A prospective study was conducted including 45 pregnant women with PE (stratified by onset type and severity) and 45 gestational age-matched normotensive controls. Serum TSP-4 concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Group differences were analyzed, and receiver operating characteristic (ROC) curves were generated to assess the diagnostic performance of TSP-4 for PE and its prognostic value for adverse outcomes. Maternal TSP-4 levels were significantly elevated in PE patients compared to controls. Using a cutoff value of >6.42 ng/mL, TSP-4 levels could distinguish PE cases with a sensitivity of 86%, a specificity of 73%, and an area under the curve (AUC) of 0.891 (P = 0.001). At a cutoff of >7.22 ng/mL, it was significantly associated with composite adverse neonatal outcomes, with a sensitivity of 76%, a specificity of 74%, and an AUC of 0.742 (P = 0.001). At a cutoff of >9.72 ng/mL, it was significantly associated with severe PE, with a sensitivity of 70%, a specificity of 74%, and an AUC of 0.792 (P = 0.001). Maternal serum TSP-4 is a promising biomarker in PE, reflecting disease presence and severity. Elevated TSP-4 levels, particularly in early-onset and severe cases, underscore its pathophysiological role and potential utility for clinical diagnosis and risk stratification in affected pregnancies.