New indicators of known markers in early prediction of the increase in the severity of preeclampsia

BACKGROUND: Preeclampsia (PE) is a multisystem complication that affects 2-8% of pregnant women and contributes significantly to maternal and perinatal morbidity and mortality. AIM: to determine the prognostic value of sFlt-1, PlGF levels and sFlt-1/PlGF ratio for predicting the development and increasing severity of pre-eclampsia within two weeks. METHODS: A prospective cohort study was conducted, which included 64 patients with singleton pregnancy complicated by arterial hypertension and/or proteinuria admitted to the S.S. Yudin Municipal Clinical Hospital of Moscow at 22-38 weeks' gestation. Venous blood was collected from all pregnant women on admission to determine the concentration of sFlt-1, PlGF and sFlt-1/PlGF ratio. Depending on the variant of the course and outcome of pregnancy, the patients were divided into 2 groups. Group I consisted of 30 (54.5%) women with pre-eclampsia, in whom there was an increase in the severity of the mother's condition and/or deterioration of the fetus's condition, which required early delivery. Group II consisted of 25 (45.5%) women with a stable course of arterial hypertension, so that it was possible to prolong the pregnancy to term against the background of the treatment, according to clinical recommendations. The first group was divided into 2 subgroups depending on the term of delivery. The first subgroup (Ia) included women delivered within 2 weeks. The second subgroup (Ib)  included women delivered more than 2 weeks later. RESULTS: As a result of the analysis, sFlt-1 levels and sFlt-1/PlGF ratios were statistically significantly different between the groups (p 0.01 and p = 0.011, respectively); however, no statistically significant differences were found when assessing PlGF levels (p=0.076). The threshold values of sFlT-1 levels and sFlt-1/PlGF ratio indicating a high risk of PE requiring early delivery were 30297 pg/ml and 3030, respectively. In the next stage of our study, we determined the threshold values of these markers predicting the severity of PE within 2 weeks, which were 23497.0 pg/ml and 977.7 for sFlt-1 and sFlt-1/PlGF ratio, respectively. CONCLUSION: This study identified sFlt-1 thresholds and sFlt-1/PlGF ratios that indicate a high risk of PE in patients with first non-specific symptoms. Moreover, we identified threshold values that determine a high probability of increasing severity of PE requiring delivery within 2 weeks.